Preoperative Evaluation Of Neurovascular Relationships For Microvascular Decompression: Visualization Using Brainvis In Patients With Idiopathic Trigeminal Neuralgia

Objective: A precise and accurate evaluation of neurovascular relationships in patients with idiopathic trigeminal neuralgia (ITN) scheduled for microvascular decompression is necessary. Thus, we constructed and evaluated a fusion imaging technique combining multi-source heterogeneous imaging data from three-dimensional magnetic resonance (MR) and computerized tomography venoangiography (CTV), which enabled use of virtual reality to preoperatively assess the neurovascular relationships, in patients with ITN scheduled for microvascular decompression. Methods: A single-center observational study. In total, eight patients with ITN scheduled for microvascular decompression were included. Patients underwent three-dimensional MR imaging with time-of-flight (TOF) and fast imaging employing steady state acquisition (FIESTA) sequences and CTV before microvascular decompression. A fusion imaging technique, combining MR-TOF, MR-FIESTA, and CTV images, was used to construct a three-dimensional model with information regarding the facial and auditory nerves, brain tissue, skull, arteries and veins. The positions of the trigeminal nerve and the responsible vessels were observed. The agreement between intraoperative neurovascular compression findings and preoperative evaluation results, and the duration required to determine the neurovascular relationships, were evaluated. Results: The neurovascular relationships as determined with the fusion imaging technique were consistent with intraoperative neurovascular compression findings in all patients. Moreover, the assessment duration was significantly shorter with the fusion imaging technique than with the three-dimensional MR (P<0.05). The rate of an accurate assessment was significantly higher with the fusion imaging technique than with threedimensional MR (P<0.05). Conclusions: The fusion imaging technique is a useful tool for the diagnosis and decision-making process based on neurovascular relationships in patients with ITN scheduled for microvascular decompression.