Preoperative visualization of neurovascular contact with 3D-FIESTA combined with 3D-TOF MRA to guide microvascular decompression surgery planning

Abstract

Background:Neurovascular compression syndromes including trigeminal neuralgia (TN) and hemifacial spasm (HFS) are caused by neurovascular conflicts at the root entry zone of the corresponding cranial nerves in the posterior fossa. Microvascular decompression (MVD) is the best choice for the treatment of TN and HFS. An accurate delineation of the responsible vessel could decrease the rate of possible operative complications such as nerve paresis.Methods:In this study, three-dimensional fast imaging employing steady-state acquisition (3D-FIESTA) and three-dimensional time-of-flight magnetic resonance angiography (3D-TOF MRA) were performed on 113 patients with TN or HFS. The imaging data were compared to the intraoperative findings and the accuracy of the data was calculated among the different responsible blood vessels and disease types. The accuracy of the data among different genders, disease durations, disease sides, and disease types was also calculated to identify the target patients for the preoperative diagnostic approach with 3D-FIESTA combined with 3D-TOF MRA.Results:The accuracy of detection with the imaging was above 75% in cases with single-vessel compression. Among these, the accuracy of the preoperative imaging result was the highest when the lesions were in the superior cerebellar artery (SCA; 91.1%). In cases of multiple-vessel compression, however, the coincidence between the preoperative and intraoperative results was only 30.0%. In most of the cases of TN, the responsible blood vessels were in the SCA, and the accuracy in the SCA reached 94.9%. In HFS patients, the responsible blood vessels were in the anterior inferior cerebellar artery (AICA) and posterior inferior cerebellar artery (PICA), and the accuracy was 86.8% and 90.0%, respectively. The differences in the accuracy of the data among different genders, disease durations, disease sides, and disease types were not statistically significant.Conclusion:This study verified the clinical instructional value of 3D-FIESTA combined with 3D-TOF MRA in MVD, and showed that this preoperative examination is reliable for all genders, disease durations, disease sides, and disease types.

The value of multimodal imaging fusion in preoperative visualization assessment of neurovascular relationship in hemifacial spasm: a single-center retrospective study

“…This may affect the assessment of NVC [21]. The 3D-TOF MRA sequence has an advantage in displaying arteries with moderate to high blood ow velocity, providing good contrast with nerves and cerebrospinal uid [2]. While the 3D-FIESTA sequence can show smaller diameter arteries or veins with slower blood ow velocities that are di cult to display with 3D-TOF MRA, it may show uneven enhancement signals for arteries with moderate to high blood ow velocities, resulting in unclear images.…”

Intraoperative Findings of Inferior Petrosal Vein During Microvascular Decompression for Hemifacial Spasm: A Single-Surgeon Experience

“…These developments, while undeniably positive, have also led to an increase demand by patients for even better outcomes and fewer complications (3,4). Despite improvements in surgical technology and procedures, the risk of postoperative complications remains a significant challenge and strategies to mitigate this risk are active areas of investigation (5)(6)(7). Neurosurgeons are increasingly paying more attention to the influence of superior petrosal veins in the treatment of trigeminal neuralgia (8)(9)(10)(11)(12).…”

The spatial arrangement of cells in a 3D-printed biomimetic spinal cord promotes directional differentiation and repairs the motor function after spinal cord injury

“…On the other hand, due to the transverse and longitudinal selectivity of the channel, these scaffolds may promote an uncontrollable extension of the axons of regenerative neurons. Theoretically, they could compromise the directional regeneration and growth of axons and cause scar tissue tangles [23][24][25][26][27]. To solve this issue, we designed sophisticated 3D-bioprinted scaffolds with single horizontal axis channel combinations to generate functional spinal cord tissues with suitable cytoarchitecture networks.…”