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Zhenzhu L, Jingfeng Z, Wei Z, Jianjun Z, Yinshui X. A novel non-segmented inverted water outline rendering method can improve the tracking of responsible blood vessels for hemifacial spasm. Front Neurosci 2024; 18:1296019. [PMID: 38352044 PMCID: PMC10861737 DOI: 10.3389/fnins.2024.1296019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/09/2024] [Indexed: 02/16/2024] Open
Abstract
This study aimed to explore a novel, non-segmented based on inverted water outline, and rapid 3D rendering method for identifying the responsible blood vessels for hemifacial spasm. First, the software was developed using the free and open-source 3D Slicer to process magnetic resonance images. Outlines of the water region were extracted and rendered in a three-dimensional space. The traditional image re-slicing technique (IMRT) was used for the control group, while non-segmented inverted water outline rendering (NSIWR) was used to observe the relevant blood vessels in the root entry/exit zone (REZ) of patients with hemifacial spasm. The intraoperative exploration results were considered the gold standard for comparing the differences in identifying relevant blood vessels between the two methods. Twenty-five patients were included, and the reconstruction effect evaluation suggested that NSIWR could effectively reconstruct the responsible blood vessels of the cochlea, facial nerve, and REZ. Compared with IMRT, NSIWR effectively improved the diagnosis of the responsible blood vessels in the REZ, clarified their sources and directions, and was consistent with intraoperative results. This study introduced a novel rapid rendering method based on NSIWR, which was successfully applied for hemifacial spasm. The method enhances accuracy in identifying responsible blood vessels in the REZ without needing multi-modal techniques. It has the potential to improve surgical effectiveness and reduce exploration time in treating hemifacial spasm.
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Affiliation(s)
- Li Zhenzhu
- Radiology Department, Ningbo NO.2 Hospital, Ningbo, China
- Department of Neurosurgery, Ningbo NO.2 Hospital, Ningbo, China
- Faculty of Electrical Engineering and Computer Science, Ningbo University, Ningbo, China
| | - Zhang Jingfeng
- Radiology Department, Ningbo NO.2 Hospital, Ningbo, China
| | - Zhou Wei
- Department of Neurosurgery, Ningbo NO.2 Hospital, Ningbo, China
| | - Zheng Jianjun
- Radiology Department, Ningbo NO.2 Hospital, Ningbo, China
| | - Xia Yinshui
- Faculty of Electrical Engineering and Computer Science, Ningbo University, Ningbo, China
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Hastreiter P, Maliachova O, Fahlbusch R, Doerfler A, Buchfelder M, Naraghi R. Comparing 1.5 T and 3.0 T MR data for 3D visualization of neurovascular relationships in the posterior fossa. Acta Neurochir (Wien) 2023; 165:3853-3866. [PMID: 37999915 PMCID: PMC10739234 DOI: 10.1007/s00701-023-05878-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/26/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Neurovascular relationships in the posterior fossa are more frequently investigated due to the increasing availability of 3.0 Tesla MRI. For an assessment with 3D visualization, no systematic analyzes are available so far and the question arises as to whether 3.0 Tesla MRI should be given preference over 1.5 Tesla MRI. METHODS In a prospective study, a series of 25 patients each underwent MRI investigations with 3D-CISS and 3D-TOF at 1.5 and 3.0 Tesla. For both field strengths separately, blood vessel information from the TOF data was fused into the CISS data after segmentation and registration. Four visualizations were created for each field strength, with and without optimization before and after fusion, which were evaluated with a rating system and verified with the intraoperative situation. RESULTS When only CISS data was used, nerves and vessels were better visualized at 1.5 Tesla. After fusion, flow and pulsation artifacts were reduced in both cases, missing vessel sections were supplemented at 3.0 Tesla and 3D visualization at 1.5 and 3.0 Tesla led to anatomically comparable results. By subsequent manual correction, the remaining artifacts were further eliminated, with the 3D visualization being significantly better at 3.0 Tesla, since the higher field strength led to sharper contours of small vessel and nerve structures. CONCLUSION 3D visualizations at 1.5 Tesla are sufficiently detailed for planning microvascular decompression and can be used without restriction. Fusion further improves the quality of 3D visualization at 3.0 Tesla and enables an even more accurate delineation of cranial nerves and vessels.
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Affiliation(s)
- Peter Hastreiter
- Department of Neurosurgery, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany.
| | - Olga Maliachova
- Department of Neurosurgery, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
- Pediatric Department, Triemli Hospital, Zurich, Switzerland
| | - Rudolf Fahlbusch
- Clinic for Endocrine Neurosurgery, International Neuroscience Institute, Hanover, Germany
| | - Arnd Doerfler
- Department of Neuroradiology, University Hospital Erlangen, Erlangen, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Ramin Naraghi
- Department of Neurosurgery, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
- Department of Neurosurgery, German Federal Armed Forces Central Hospital Koblenz, Koblenz, Germany
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Basamh M, Sinning N, Ajabnoor W, Illies T, Kehler U. Preoperative assessment of the individual anatomy of the superior petrosal vein complex using balanced fast field echo magnetic resonance imaging. Surg Radiol Anat 2023; 45:1273-1285. [PMID: 37548655 DOI: 10.1007/s00276-023-03220-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 07/24/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Here, we sought to examine the validity and reproducibility of balanced fast field echo (bFFE) for assessing superior petrosal vein (SPV) complex (SPVC) anatomy. METHODS Preoperative bFFE or equivalent scans and operative videos were studied and directly compared with regard to the individual anatomical features of SPVCs and their relation to the operative field. The anatomical details of the bFFE findings of the non-operated side (group 2) of all 50 patients were then reviewed, including the presence of petrosal-galenic anastomosis, and finally compared to the operated SPVCs (group 1). RESULTS A complete correlation between bFFE and intraoperative findings was observed in 62% of cases and had a significant correlation with 3 Tesla magnet strength and higher pixel bandwidth (rbis = - 0.47; p = 0.005). The sensitivity and specificity of bFFE magnetic resonance imaging were 93.7 and 95.2%, respectively, for detecting an SPV disturbing the operative field, and 97.3% and 95% for a disturbing tributary, respectively. Each group had 50 SPVCs, with a total of 70 and 64 SPVs, 10 and 11 general SPVC configurations, as well as 29 and 28 different individual anatomical variations in groups 1 and 2, respectively. Both groups had 1-3 SPVs with a similar distribution of frequencies [Chi-square (4) = 27.56; p = 0.0145 (Fisher's exact test)]. The similarity of the general configurations was not statistically significant. The same four predominant configurations constituted 80% of the SPVCs in each group. The vein of the cerebellopontine fissure was most frequently found in 86% and 88% of cases, and a petrosal-galenic anastomosis was seen in 38% and 40% of groups 1 and 2, respectively. CONCLUSIONS Individual SPVC variations are extensive. Good quality bFFE or equivalents are feasible for preoperative SPVC assessments. However, methods improving vascular visualization are recommended.
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Affiliation(s)
- Mohammed Basamh
- Division of Neurosurgery, King Abdul-Aziz University Hospital, P. O. Box 80125, 21589, Jeddah, Saudi Arabia.
| | - Nico Sinning
- Department of Neurosurgery, Asklepios Klinik Altona, Hamburg, Germany
| | - Waleed Ajabnoor
- Department of Radiology, King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia
| | - Till Illies
- Department of Neuroradiology, Asklepios Klinik Altona, Hamburg, Germany
| | - Uwe Kehler
- Department of Neurosurgery, Asklepios Klinik Altona, Hamburg, Germany
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Iwata T, Hosomi K, Tani N, Khoo HM, Oshino S, Kishima H. Utilization of three-dimensional fusion images with high-resolution computed tomography angiography for preoperative evaluation of microvascular decompression: patient series. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 6:CASE23330. [PMID: 37728326 PMCID: PMC10555555 DOI: 10.3171/case23330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/31/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND High-resolution computed tomography (CT), outfitted with a 0.25-mm detector, has superior capability for identifying microscopic anatomical structures compared to conventional CT. This study describes the use of high-resolution computed tomography angiography (CTA) for preoperative microvascular decompression (MVD) assessment and explores the potential effectiveness of three-dimensional (3D) image fusion with magnetic resonance imaging (MRI) by comparing it with traditional imaging methods. OBSERVATIONS Four patients who had undergone preoperative high-resolution CTA and MRI for MVD at Osaka University Hospital between December 2020 and March 2022 were included in this study. The 3D-reconstructed images and intraoperative findings were compared. One patient underwent conventional CTA, thus allowing for a comparison between high-resolution and conventional CTA in terms of radiation exposure and vascular delineation. Preoperative simulations reflected the intraoperative findings for all cases; small vessel compression of the nerve was identified preoperatively in two cases. LESSONS Compared with conventional CTA, high-resolution CTA showed superior vascular delineation with no significant change in radiation exposure. The use of high-resolution CTA with reconstructed 3D fusion images can help to simulate prior MVD. Knowing the location of the nerves and blood vessels can perioperatively guide neurosurgeons.
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Mulford KL, Moen SL, Darrow DP, Grande AW, Nixdorf DR, Van de Moortele PF, Özütemiz C. Probabilistic tractography of the extracranial branches of the trigeminal nerve using diffusion tensor imaging. Neuroradiology 2023:10.1007/s00234-023-03184-z. [PMID: 37347460 DOI: 10.1007/s00234-023-03184-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/12/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE The peripheral course of the trigeminal nerves is complex and spans multiple bony foramen and tissue compartments throughout the face. Diffusion tensor imaging of these nerves is difficult due to the complex tissue interfaces and relatively low MR signal. The purpose of this work is to develop a method for reliable diffusion tensor imaging-based fiber tracking of the peripheral branches of the trigeminal nerve. METHODS We prospectively acquired imaging data from six healthy adult participants with a 3.0-Tesla system, including T2-weighted short tau inversion recovery with variable flip angle (T2-STIR-SPACE) and readout segmented echo planar diffusion weighted imaging sequences. Probabilistic tractography of the ophthalmic, infraorbital, lingual, and inferior alveolar nerves was performed manually and assessed by two observers who determined whether the fiber tracts reached defined anatomical landmarks using the T2-STIR-SPACE volume. RESULTS All nerves in all subjects were tracked beyond the trigeminal ganglion. Tracts in the inferior alveolar and ophthalmic nerve exhibited the strongest signal and most consistently reached the most distal landmark (58% and 67%, respectively). All tracts of the inferior alveolar and ophthalmic nerve extended beyond their respective third benchmarks. Tracts of the infraorbital nerve and lingual nerve were comparably lower-signal and did not consistently reach the furthest benchmarks (9% and 17%, respectively). CONCLUSION This work demonstrates a method for consistently identifying and tracking the major nerve branches of the trigeminal nerve with diffusion tensor imaging.
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Affiliation(s)
- Kellen L Mulford
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA.
| | - Sean L Moen
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - David P Darrow
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Andrew W Grande
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Donald R Nixdorf
- Department of Diagnostic and Biological Sciences, University of Minnesota, Minneapolis, MN, USA
| | | | - Can Özütemiz
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
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The practical limits of high-quality magnetic resonance imaging for the diagnosis and classification of trigeminal neuralgia. Clin Neurol Neurosurg 2022; 221:107403. [PMID: 35933966 DOI: 10.1016/j.clineuro.2022.107403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Neurovascular compression (NVC) has been the primary hypothesis for the underlying mechanism of classical trigeminal neuralgia (TN). However, a substantial body of literature has emerged highlighting notable exceptions to this hypothesis. The purpose of this study is to assess the reliability and diagnostic accuracy of high resolution, high contrast MRI-determined neurovascular contact for TN. METHODS We performed a retrospective, randomized, and blinded parallel characterization of neurovascular interaction and diagnosis in a population of TN patients and controls using four expert reviewers. Performance statistics were calculated, as well as assessments for generalizability using shuffled bootstraps. RESULTS Fair to moderate agreement (ICC: 0.32-0.68) about diagnosis between reviewers was observed using MRIs from 47 TN patients and 47 controls. On average reviewers performed no better than chance when diagnosing participants, with an accuracy of 0.57 (95% CI 0.40, 0.59) per patient. CONCLUSION While MRI is useful in determining structural causes in secondary TN, expert reviewers do no better to only slightly better than chance with distinguishing TN with MRI, despite moderate agreement. Further, the causal role of NVC for TN is not clear, limiting the applicability of MRI to diagnose or prognosticate treatment of TN.
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Data fusion and 3D visualization for optimized representation of neurovascular relationships in the posterior fossa. Acta Neurochir (Wien) 2022; 164:2141-2151. [PMID: 35015156 PMCID: PMC9338141 DOI: 10.1007/s00701-021-05099-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/21/2021] [Indexed: 12/03/2022]
Abstract
Background Reliable 3D visualization of neurovascular relationships in the posterior fossa at the surface of the brainstem is still critical due to artifacts of imaging. To assess neurovascular compression syndromes more reliably, a new approach of 3D visualization based on registration and fusion of high-resolution MR data is presented. Methods A total of 80 patients received MRI data with 3D-CISS and 3D-TOF at 3.0 Tesla. After registration and subsequent segmentation, the vascular information of the TOF data was fused into the CISS data. Two 3D visualizations were created for each patient, one before and one after fusion, which were verified with the intraoperative situation during microvascular decompression (MVD). The reproduction quality of vessels was evaluated with a rating system. Results In all cases, the presented approach compensated for typical limitations in the 3D visualization of neurovascular compression such as the partial or complete suppression of larger vessels, suppression of smaller vessels at the CSF margin, and artifacts from heart pulsation. In more than 95% of the cases of hemifacial spasm and glossopharyngeal neuralgia, accurate assessment of the compression was only possible after registration and fusion. In more than 50% of the cases with trigeminal neuralgia, the presented approach was crucial to finding the actually offending vessel. Conclusions 3D visualization of fused image data allows for a more complete representation of the vessel-nerve situation. The results from this approach are reproducible and the assessment of neurovascular compression is safer. It is a powerful tool for planning MVD.
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Pham HD, Dang TH, Duong TK, Dinh TT, Bui VG, Nguyen TV, Huynh QH. Predictability of Fused 3D-T2-SPACE and 3D-TOF-MRA Images in Identifying Conflict in Trigeminal Neuralgia. J Pain Res 2021; 14:3421-3428. [PMID: 34754235 PMCID: PMC8570429 DOI: 10.2147/jpr.s331054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 10/22/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the efficacy of fused three-dimensional T2 sampling perfection with application-optimized contrasts using different flip-angle evolutions (3D-SPACE) and three-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA) sequences for detecting neurovascular compression (NVC) in patients presenting with trigeminal neuralgia (TN). Methods A prospective study was carried in 33 consecutive patients (m/f: 17/16; mean age, 56.3 ± 10.4 years) with unilateral TN confirmed NVC and consensus by two experienced radiologists on fused 3D-SPACE and 3D-TOF-MRA sequences of 3-tesla (3-T) MRI. All patients underwent microvascular decompression (MVD), using photos and video in surgery as documents compared with MRI. Both the MRI and MVD were reported for three grades (contact, compression, distortion), vessel types (artery or vein), identification of offending vessel, site (juxtapontine, cisternal, and juxtapetrous), and location (cranial, caudal, medial, lateral). Agreement between preoperative MRI visualization and surgical findings was assessed using the kappa (K) statistic. Results The k-values for the agreement were excellent for the grade of NVC (k=0.82), vessel types (k=0.78), and location of conflict (k=0.74), and good for identification of the offending vessel (0.65) and the site-affected vessel (k=0.69). Conclusion The fused D3-SPACE and 3D-TOF-MRA images are highly effective tools for the evaluation and treatment planning of NVC in TN patients.
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Affiliation(s)
- Hong Duc Pham
- Radiology Department, Saint Paul Hospital of Hanoi, Hanoi City, Vietnam.,Radiology Department, Hanoi Medical University, Hanoi City, Vietnam
| | - Thu Ha Dang
- Radiology Department, Saint Paul Hospital of Hanoi, Hanoi City, Vietnam.,Radiology Department, Hanoi Medical University, Hanoi City, Vietnam
| | - Trung Kien Duong
- Neurosurgery Department, Saint Paul Hospital of Hanoi, Hanoi City, Vietnam
| | - Trung Thanh Dinh
- Radiology Department, Saint Paul Hospital of Hanoi, Hanoi City, Vietnam
| | - Van Giang Bui
- Radiology Department, Hanoi Medical University, Hanoi City, Vietnam.,Radiology Centre, National Cancer Hospital, Hanoi City, Vietnam
| | - Tuan Vu Nguyen
- Cardiology Department, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Quang Huy Huynh
- Radiology Department, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.,Radiology Department, Trưng Vương Hospital, Ho Chi Minh City, Vietnam
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Proton MR spectroscopic features of the cisternal segment of the trigeminal nerve in patients with trigeminal neuralgia: A pilot study. Clin Imaging 2021; 74:93-99. [PMID: 33465667 DOI: 10.1016/j.clinimag.2020.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 11/15/2020] [Accepted: 12/17/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE To investigate normal quantitative proton magnetic resonance spectroscopy (MRS) features of the cisternal segment of the trigeminal nerve and evaluate possible metabolite concentration differences in the affected and unaffected nerves of trigeminal neuralgia patients. MATERIAL AND METHODS A total of 33 consecutive patients who underwent a MR study of the internal auditory canal/posterior fossa and dedicated trigeminal nerve multivoxel MRS were enrolled. Measurements of N-acetyl aspartate (NAA), creatine (Cr), choline (Cho), myoinositol (mI), glutamate-glutamine (Glx) concentrations, and ratios of NAA-to-Cr, Cho-to-Cr, and Cho-to-NAA were automatically calculated by the dedicated software. Vascular conflicts were also recorded. RESULTS The mean Cr concentration was significantly higher on the affected sides in all parts of the nerve (p < 0.05), while the mean NAA concentration was significantly higher in only the distal portion (p = 0.04). Mean mI concentration was significantly higher in the middle and distal parts (p < 0.05). NAA-to-Cr ratio was significantly higher in the proximal and middle parts (p < 0.05), while Cho-to-Cr ratio was significantly higher only in the middle portion (p = 0.028). Finally, the Cho-to-NAA ratio was significantly higher only in the distal portion (p = 0.04). Vascular conflicts were observed in 24 patients (72.7%), and in 20 of them (60.6%) the conflict was on the same side as the neuralgia symptoms. CONCLUSION Although the detected statistical relationships were variable in the spectroscopic measurements, metabolite concentrations and ratios were successfully exhibited in all patients. Features of a normal trigeminal nerve were able to determine by MRS. All calculated metabolite concentrations were higher in the affected nerves; however, only some of them were statistically significant. No statistically significant relationships were found between the MRS measurements and nerves with and without vascular compression.
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A segmentation-independent volume rendering visualisation method might reduce redundant explorations and post-surgical complications of microvascular decompression. Eur Radiol 2020; 30:3823-3833. [PMID: 32103364 DOI: 10.1007/s00330-020-06715-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/02/2020] [Accepted: 02/05/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This study aimed to investigate the feasibility of segmentation-independent volume rendering (SI-VR) in visualising the root entry zone (REZ), and to explore the influence on the management of vascular compression syndromes (VCSs). METHODS Two hundred and twenty patients with VCSs were recruited in this prospective study from July 2015 to May 2019. SI-VR was reconstructed based on inverted 3D fast spin echo T2WI. They were assigned to the experimental group and control group randomly. Patients in the experimental group would accept extra evaluation based on SI-VR before microvascular decompression. Image quality and diagnostic accuracy between SI-VR and 3D fast spin echo T2WI in the experimental group were compared by Mann-Whitney U test and chi-square test, separately. Interobserver agreement was performed with intraclass correlation coefficient. Postsurgical outcomes and complications between two groups were compared by chi-square test. RESULTS SI-VR had a better interobserver agreement (0.82 vs 0.68) and diagnostic accuracy (95.5% vs 83.6%, p = 0.004) than that of 3D fast spin echo T2WI. Especially, significantly improved diagnostic accuracy was reached in detecting the multi-vascular branches compression (100% vs 15.4%, p < 0.001). There were fewer complications (7.1% vs 26.8%, p = 0.004) and less operation time (20.7 min vs 14.5 min, p = 0.007) but no significant difference of pain relief (p = 0.19) in the experimental group than in the control group. CONCLUSIONS The SI-VR method is feasible for the precise demonstration of the anatomy structure along the REZ, with high reliability and reproducibility. Unbiased pre-surgical visualisation could reduce redundant explorations and post-surgical complications in patients who undergo microvascular decompression. KEY POINTS • Visualisation of the root entry zone by the segmentation-independent volume rendering is in accordance with the landscape by the neuro-endoscopy. • Segmentation-independent volume rendering has an advantage over 3D fast spin echo T2WI in the visualisation of multi-vascular branches compression. • Presurgical 3D visualisation of the neurovascular compression at the root entry zone leads to less postsurgical complications from the decrease of redundant exploration.
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Basamh M, Sinning N, Kehler U. Individual variations of the superior petrosal vein complex and their microsurgical relevance in 50 cases of trigeminal microvascular decompression. Acta Neurochir (Wien) 2020; 162:197-209. [PMID: 31768757 PMCID: PMC6942005 DOI: 10.1007/s00701-019-04109-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/14/2019] [Indexed: 11/24/2022]
Abstract
Background We investigated the understudied anatomical variations of the superior petrosal vein (SPV) complex (SPVC), which may play some role in dictating the individual complication risk following SPVC injury. Methods Microvascular decompressions of the trigeminal nerve between September 2012 and July 2016. All operations utilized an SPVC preserving technique. Preoperative balanced fast field echo (bFFE) magnetic resonance imaging, or equivalent sequences, and operative videos were studied for individual SPVC anatomical features. Results Applied imaging and operative SPVC anatomy were described for fifty patients (mean age, 67.18 years; female sex and right-sided operations, 58% each). An SPVC component was sacrificed intentionally in 6 and unintentionally in only 7 cases. Twenty-nine different individual variations were observed; 80% of SPVCs had either 2 SPVs with 3 or 1 SPV with 2, 3, or 4 direct tributaries. Most SPVCs had 1 SPV (64%) and 2 SPVs (32%). The SPV drainage point into the superior petrosal sinus was predominantly between the internal auditory meatus and Meckel cave (85.7% of cases). The vein of the cerebellopontine fissure was the most frequent direct tributary (86%), followed by the pontotrigeminal vein in 80% of SPVCs. Petrosal-galenic anastomosis was detected in at least 38% of cases. At least 1 SPV in 54% of the cases and at least 1 direct tributary in 90% disturbed the operative field. The tributaries were more commonly sacrificed. Conclusions The extensive anatomical variation of SPVC is depicted. Most SPVCs fall into 4 common general configurations and can usually be preserved. BFFE or equivalent sequences remarkably facilitated the intraoperative understanding of the individual SPVC in most cases.
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Affiliation(s)
- Mohammed Basamh
- Department of Neurosurgery, Asklepios Klinik Altona, Paul-Ehrlich Strasse 1, 22763, Hamburg, Germany.
- Division of Neurosurgery, King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia.
| | - Nico Sinning
- Department of Neurosurgery, Asklepios Klinik Altona, Paul-Ehrlich Strasse 1, 22763, Hamburg, Germany
| | - Uwe Kehler
- Department of Neurosurgery, Asklepios Klinik Altona, Paul-Ehrlich Strasse 1, 22763, Hamburg, Germany
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Arrighi-Allisan AE, Delman BN, Rutland JW, Yao A, Alper J, Huang KH, Balchandani P, Shrivastava RK. Neuroanatomical Determinants of Secondary Trigeminal Neuralgia: Application of 7T Ultra-High-Field Multimodal Magnetic Resonance Imaging. World Neurosurg 2019; 137:e34-e42. [PMID: 31790844 DOI: 10.1016/j.wneu.2019.11.130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/21/2019] [Accepted: 11/22/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Seven-Tesla (7T) magnetic resonance imaging (MRI) has demonstrated value for evaluating a variety of intracranial diseases. However, its utility in trigeminal neuralgia has received limited attention. The authors of the present study applied ultra-high field multimodal MRI to two representative patients with secondary trigeminal neuralgia due to epidermoid tumors to illustrate the possible clinical and surgical advantages of 7T compared with standard clinical strength imaging. Techniques included co-registration of multiple 7T sequences to optimize the detection of potential concurrent neurovascular and neoplasm-derived compression. METHODS 7T MRI studies were performed using a whole body scanner. Two- and three-dimensional renderings of potential neurovascular conflict were created by co-registering time-of-flight angiography and T2-weighted turbo spin echo images in MATLAB and GE software. Detailed comparisons of the various field strength images were provided by a collaborating neuroradiologist (B.D.). RESULTS 7T MRI clearly illustrated minute tumor-adjacent vasculature. In contrast, conventional, low-field imaging did not consistently provide adequate details to distinguish cerebrospinal fluid pulsatility from vessels. The tumor margins, although distinct from the trigeminal nerve fibers at 7T, blended with those of the surrounding structures at 3T. Two- and three-dimensional co-registration of time-of-flight angiography with T2-weighted MRI suggested that delicate, intervening vasculature may have contributed to these illustrative patients' symptomatology. CONCLUSIONS 7T provided superior visualization of vital landmarks and subtle nerve and vessel features. Co-registration of various advanced 7T modalities may help to resolve complex disease etiologies. Future studies should explore the extent to which this dual etiology might persist across tumor types and utilize diffusion-based techniques to quantify what microstructural differences might exist between patients with trigeminal neuralgia from varying etiologies.
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Affiliation(s)
- Annie E Arrighi-Allisan
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Bradley N Delman
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John W Rutland
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA; BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amy Yao
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Judy Alper
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kuang-Han Huang
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Priti Balchandani
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Raj K Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Li J, Wang Y, Lian Z, Liu R, Liang Z, Song C, Song Q, Wei Z. The Value of Three-Dimensional Brain Volume Combined with Time-of-Flight MRA in Microvascular Decompression. Stereotact Funct Neurosurg 2019; 97:120-126. [PMID: 31288239 DOI: 10.1159/000500995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 05/08/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To explore the guidance value of preoperative 3-dimensional brain volume (3D-BRAVO) and 3-dimensional time-of-flight (3D-TOF) MRA scanning for microvascular decompression. METHODS One hundred thirteen patients treated with microvascular decompression from February 2016 to February 2018 in the First Affiliated Hospital of Dalian Medical University were retrospectively analyzed. All patients received 3D-BRAVO combined with 3D-TOF MRA sequence reconstruction before the operation. The anatomical relationship of neurovascular tissues was analyzed and compared with the results of intraoperative exploration. RESULTS The results of MVD showed that the number of positive cases was 108 (95.6%) on the diseased side. 3D-BRAVO combined with 3D-TOF sequence reconstruction resulted in 106 positive cases (93.8%), with a 98.1% positive coincidence rate and a 13.2% false positive rate (p < 0.05). 3D-BRAVO-TOF sequence reconstruction of trigeminal neuralgia showed a positive coincidence in 78 cases (92.8%) and for hemifacial spasm a positive coincidence was found in 27 cases (93.1%). CONCLUSION 3D-BRAVO combined with 3D-TOF sequence reconstruction before microvascular decompression can fully evaluate the morphology, location, and anatomical relationship of lesions, which is of guidance value for clinical diagnosis and treatment.
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Affiliation(s)
- Jun Li
- Department of Neurosurgery, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ying Wang
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhigang Lian
- Department of Neurosurgery, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Rongyao Liu
- Department of Neurosurgery, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhanhua Liang
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Chunli Song
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qingwei Song
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhenqing Wei
- Department of Neurosurgery, First Affiliated Hospital of Dalian Medical University, Dalian, China,
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14
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Kumar K, Das KK, Singh S, Khatri D, Deora H, Singh J, Bhaisora K, Srivastava AK, Jaiswal AK, Behari S. Vascular Offenders in Trigeminal Neuralgia: A Unified Classification and Assessment of the Outcome of Microvascular Decompression. World Neurosurg 2019; 127:e366-e375. [PMID: 30905645 DOI: 10.1016/j.wneu.2019.03.128] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 03/12/2019] [Accepted: 03/13/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Vascular loop compression remains the most accepted theory for trigeminal neuralgia (TN). Apart from the normal adjoining vascular loops, certain unusual vascular loops incriminated in TN such as vertebrobasilar dolichoectasia and pure venous compressions do not truly fit into the traditional classification. Moreover, vascular diseases such as cavernoma and aneurysms causing TN are considered as secondary TNs. There is a lack of unified classification for TN with underlying vascular offenders, otherwise amenable to microvascular decompression. METHODS We classified vascular offenders in TN (n = 53) into the usual offenders such as superior cerebellar artery or anterior inferior cerebellar artery loop with (n = 4) or without (n = 34) superior petrosal vein loop (n = 38, group I). The unusual vascular offenders (n = 15, group II) comprised unusual arterial loops (n = 4, IIa), pure venous compressions (n = 8, IIb) and vascular diseases (n = 3, IIc). The clinical symptoms, pain severity scores, and surgical outcomes were compared. RESULTS A right-sided preference and male predominance typified the unusual group. The incidence of atypical pain and sensory impairment was higher in group II. Group II also showed a less favorable immediate pain outcome, particularly the patients in group IIb. Group IIb also showed a higher incidence of postoperative hemorrhagic complications. However, long-term outcomes did not differ significantly. CONCLUSIONS Unusual vascular offenders in TN do constitute a significant population. They differ from the usual group with respect to the type of pain, gender, and side of involvement and tend to have more complications with similar pain outcomes after microvascular decompression.
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Affiliation(s)
- Krishna Kumar
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kuntal Kanti Das
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
| | - Suyash Singh
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Deepak Khatri
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Harsh Deora
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Jaskaran Singh
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kamlesh Bhaisora
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Arun K Srivastava
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Awadhesh K Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Jorquera Moya M, Merino Menéndez S, Porta Etessam J, Escribano Vera J, Yus Fuertes M. Sintomatología derivada de los pares craneales: Clínica y topografía. RADIOLOGIA 2019; 61:99-123. [DOI: 10.1016/j.rx.2018.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 09/16/2018] [Accepted: 09/27/2018] [Indexed: 10/27/2022]
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16
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Jorquera Moya M, Merino Menéndez S, Porta Etessam J, Escribano Vera J, Yus Fuertes M. Cranial nerve disorders: Clinical manifestations and topography. RADIOLOGIA 2019. [DOI: 10.1016/j.rxeng.2018.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Kanazawa T, Ohkubo M, Kondo T, Miyazawa T, Inagawa S. Improved wedge method for the measurement of sub-millimeter slice thicknesses in magnetic resonance imaging. Radiol Phys Technol 2017; 10:446-453. [DOI: 10.1007/s12194-017-0417-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/24/2017] [Accepted: 08/26/2017] [Indexed: 11/28/2022]
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