Predicting the therapeutic effect of carbamazepine in trigeminal neuralgia by analysis of neurovascular compression utilizing magnetic resonance cisternography

2019 ◽  
Vol 48 (4) ◽  
pp. 480-487 ◽  
Author(s):  
T. Tanaka ◽  
S. Shiiba ◽  
N. Yoshino ◽  
N. Harano ◽  
T. Sago ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Trigeminal Neuralgia ◽  
Therapeutic Effect ◽  
Neurovascular Compression ◽  
Magnetic Resonance Cisternography

PREDICTION OF SURGICAL VIEW OF NEUROVASCULAR DECOMPRESSION USING INTERACTIVE COMPUTER GRAPHICS

Neurosurgery ◽  
2009 ◽  
Vol 65 (1) ◽  
pp. 121-129 ◽  
Author(s):  
Taichi Kin ◽  
Hiroshi Oyama ◽  
Kyousuke Kamada ◽  
Shigeki Aoki ◽  
Kuni Ohtomo ◽  
...  
Keyword(s):  
Steady State ◽  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Computer Graphics ◽  
Trigeminal Neuralgia ◽  
Interactive Visualization ◽  
Fast Imaging ◽  
Neurovascular Compression ◽  
Visualization Method ◽  
Facial Spasm

ABSTRACT OBJECTIVE To assess the value of an interactive visualization method for detecting the offending vessels in neurovascular compression syndrome in patients with facial spasm and trigeminal neuralgia. Computer graphics models are created by fusion of fast imaging employing steady-state acquisition and magnetic resonance angiography. METHODS High-resolution magnetic resonance angiography and fast imaging employing steady-state acquisition were performed preoperatively in 17 patients with neurovascular compression syndromes (facial spasm, n = 10; trigeminal neuralgia, n = 7) using a 3.0-T magnetic resonance imaging scanner. Computer graphics models were created with computer software and observed interactively for detection of offending vessels by rotation, enlargement, reduction, and retraction on a graphic workstation. Two-dimensional images were reviewed by 2 radiologists blinded to the clinical details, and 2 neurosurgeons predicted the offending vessel with the interactive visualization method before surgery. Predictions from the 2 imaging approaches were compared with surgical findings. The vessels identified during surgery were assumed to be the true offending vessels. RESULTS Offending vessels were identified correctly in 16 of 17 patients (94%) using the interactive visualization method and in 10 of 17 patients using 2-dimensional images. These data demonstrated a significant difference (P = 0.015 by Fisher's exact method). CONCLUSION The interactive visualization method data corresponded well with surgical findings (surgical field, offending vessels, and nerves). Virtual reality 3-dimensional computer graphics using fusion magnetic resonance angiography and fast imaging employing steady-state acquisition may be helpful for preoperative simulation.

TRIGEMINAL NEURALGIA AND VASCULAR COMPRESSION IN PATIENTS WITH TRIGEMINAL SCHWANNOMAS

Neurosurgery ◽  
2008 ◽  
Vol 62 (4) ◽  
pp. E974-E975 ◽  
Author(s):  
Jonathan P. Miller ◽  
Feridun Acar ◽  
Kim J. Burchiel
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Gamma Knife Radiosurgery ◽  
Vascular Compression ◽  
Neurovascular Compression ◽  
Intracranial Tumors ◽  
Resonance Imaging

Abstract OBJECTIVE Trigeminal neuralgia (TN) is often associated with neurovascular compression. However, intracranial tumors are occasionally observed, particularly when symptoms are atypical. We describe three patients with Type-1 TN and trigeminal schwannoma diagnosed by magnetic resonance imaging, with concomitant arterial compression of the trigeminal nerve. CLINICAL PRESENTATION All three patients had Type-1 TN with spontaneous onset, paroxysm-triggered pain, and response to antiepileptic medication. Contrast-enhanced T1-weighted magnetic resonance imaging scans demonstrated an ipsilateral enhancing perineural mass consistent with a schwannoma. Two of the three patients had previously undergone gamma knife radiosurgery without improvement. Subsequent high-resolution magnetic resonance imaging in all three patients revealed obvious compression of the trigeminal nerve by an arterial structure. INTERVENTION Two patients underwent retrosigmoid craniectomy followed by microvascular decompression and remain pain-free. One patient elected not to pursue surgical intervention. CONCLUSION Although intracranial tumors are occasionally observed in patients with TN, neurovascular compression must still be considered as an etiology, especially if typical TN symptoms are reported.

Three-dimensional Visualization of Neurovascular Compression: Presurgical Use of Virtual Endoscopy Created from Magnetic Resonance Imaging

2008 ◽  
Vol 63 (suppl_1) ◽  
pp. ONS139-ONS146 ◽  
Author(s):  
Tetsuro Takao ◽  
Makoto Oishi ◽  
Masafumi Fukuda ◽  
Go Ishida ◽  
Mitsuya Sato ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Trigeminal Neuralgia ◽  
Three Dimensional ◽  
Virtual Endoscopy ◽  
Surgical Approaches ◽  
Data Sets ◽  
Neurovascular Compression ◽  
Magnetic Resonance Data ◽  
Resonance Data ◽  
Neurovascular Structures

Abstract Objective: To assess the usefulness of presurgical simulation of microvascular decompression (MVD) by virtual endoscopy (VE), a new tool to analyze three-dimensionally reconstructed magnetic resonance data sets in patients with trigeminal neuralgia or hemifacial spasm (HFS). Methods: In 17 patients (10 with trigeminal neuralgia and seven with HFS) determined to be candidates for MVD, we performed presurgical simulation of MVD using VE. We used constructive interference in steady-state imaging and magnetic resonance angiography to obtain the original images. VE findings were compared with surgical findings. Results: The three-dimensional relations between visible structures seen on VE were consistent with intraoperative findings in all patients. In total, 20 (91%) of 22 neurovascular compression sites in all 17 patients were correctly delineated on VE, with the exception of two small branches identified as offending vessel in two patients with HFS. Perforators that were not apparent on VE limited our ability to accomplish transpositioning of the offending vessels as simulated. The positions of structures that can affect individual surgical approaches, such as the petrosal vein, cerebellar flocculus, and vertebral artery, were also adequately predicted on VE. All patients had excellent surgical outcomes. Conclusion: Presurgical VE in patients with trigeminal neuralgia or HFS is a novel technique that provides excellent visualization of the three-dimensional relations between neurovascular structures and allows simulation of MVD.

Preoperative visualization of neurovascular anatomy in trigeminal neuralgia

2008 ◽  
Vol 108 (3) ◽  
pp. 477-482 ◽  
Author(s):  
Jonathan Miller ◽  
Feridun Acar ◽  
Bronwyn Hamilton ◽  
Kim Burchiel
Keyword(s):  
Magnetic Resonance ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Surgical Approach ◽  
Mr Angiography ◽  
Neurovascular Compression ◽  
Surface Rendering ◽  
Contrast Enhanced ◽  
Vascular Structures ◽  
Neurovascular Anatomy

Object The authors report on a novel technique to identify neurovascular compression in trigeminal neuralgia (TN). Using 3D reconstructed high-resolution balanced fast-field echo (BFFE) images fused with 3D time-of-flight (TOF) magnetic resonance (MR) angiography and Gd-enhanced 3D spoiled gradient recalled sequence, it is possible to objectively visualize the trigeminal nerve and nearby arteries and veins. Methods Magnetic resonance imaging was performed in 18 patients with unilateral TN using 3 sequences: BFFE, 3D TOF angiography, and 3D Gd-enhanced imaging. The images were imported into OsiriX imaging software; after their fusion, a 3D false-color reconstruction was produced using surface rendering. The reconstructed images objectively differentiate nerves and vessels and can be viewed from any angle, including the anticipated surgical approach. Results Fifteen patients were predicted to have neurovascular compression on the symptomatic side (9 arterial and 6 venous compressions). All patients had a vascular structure that was identical in location and configuration to that predicted on preoperative analysis. The 3 patients without predicted compression underwent surgical exploration because they manifested the classic symptoms. As expected, exploration in 2 of these patients revealed no offending vessel. The third patient had a small vein embedded in the trigeminal nerve that was beyond the resolution of the 3D Gd-enhanced study. Conclusions Combining BFFE with MR angiography and Gd-enhanced MR images capitalizes on the advantages of both techniques, enabling MR angiography and contrast-enhanced MR imaging discrimination of vascular structures at BFFE resolution. This results in an unambiguous 3D image that can be used to identify the neurovascular compression and plan the surgical approach.

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