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.

Three-dimensional Fast Imaging Employing Steady-state Acquisition Magnetic Resonance Imaging for Stereotactic Radiosurgery of Trigeminal Neuralgia

Neurosurgery ◽  
2005 ◽  
Vol 56 (3) ◽  
pp. E628-E628 ◽  
Author(s):  
Gabriela-del-Rocío Chávez Chávez ◽  
Antonio A.F. De Salles ◽  
Timothy D. Solberg ◽  
Alessandra Pedroso ◽  
Dulce Espinoza ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Steady State ◽  
Magnetic Resonance ◽  
Trigeminal Neuralgia ◽  
Stereotactic Radiosurgery ◽  
Trigeminal Nerve ◽  
Three Dimensional ◽  
Fast Imaging ◽  
Resonance Imaging ◽  
Entry Zone

Abstract OBJECTIVE: The aim of this study was to demonstrate the use and applications of the three-dimensional fast imaging employing steady-state acquisition (3-D-FIESTA) magnetic resonance imaging sequence in targeting and planning for stereotactic radiosurgery of trigeminal neuralgia. METHODS: A 3-D-FIESTA sequence for visualization of cranial nerves in the cranial base was added to the routine magnetic resonance imaging scan to enhance the treatment planning for trigeminal neuralgia. T1-weighted images, 1 mm thick, were directly compared with the FIESTA sequence for the exact visualization of the trigeminal entry zone and surrounding vasculature. The target accuracy was evaluated by image fusion of computed tomographic and magnetic resonance imaging scans. The anatomy visualized with the FIESTA sequence was validated by direct inspection of the gross anatomic specimens of the trigeminal complex. RESULTS: A total of 15 consecutive patients, 10 women and 5 men, underwent radiosurgery for essential trigeminal neuralgia between April and July, 2003. The mean age of the patients was 65.2 years (range, 24–83 yr). Nine patients had right-sided symptoms. Four patients had had previous surgery (two microvascular decompression, one percutaneous rhizotomy, and one radiofrequency thermocoagulation). The 3-D-FIESTA sequence successfully demonstrated the trigeminal complex (root entry zone, trigeminal ganglion, rootlets, and vasculature) in 14 patients (93.33%). The 3-D-FIESTA sequence also allowed visualization of the branches of the trigeminal nerve inside Meckel's cavity. This exact visualization correlated precisely with the anatomic specimens. In one patient (6.66%), it was not possible to demonstrate the related vasculature. However, the other structures were clearly visualized. CONCLUSION: The 3-D-FIESTA sequence is used in this study for demonstration of the exact anatomy of the trigeminal complex for the purpose of radiosurgical planning and treatment of trigeminal neuralgia. With such imaging techniques, radiosurgical targeting of specific trigeminal nerve branches may be feasible. It has not been possible previously to target individual branches of the trigeminal nerve.

Preoperative Evaluation of Neurovascular Compression in Patients with Trigeminal Neuralgia by Use of Three-dimensional Reconstruction from Two Types of High-resolution Magnetic Resonance Imaging

Neurosurgery ◽  
2002 ◽  
Vol 51 (4) ◽  
pp. 956-962 ◽  
Author(s):  
Hideaki Akimoto ◽  
Tsukasa Nagaoka ◽  
Tadashi Nariai ◽  
Yoshiaki Takada ◽  
Kikuo Ohno ◽  
...  
Keyword(s):  
Steady State ◽  
Magnetic Resonance ◽  
High Resolution ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Preoperative Evaluation ◽  
Three Dimensional ◽  
Spatial Relationship ◽  
Magnetic Resonance Images ◽  
Neurovascular Compression

Abstract OBJECTIVE To assess the value of three-dimensional (3-D) images reconstructed from 3-D constructive interference in steady state (3-D-CISS) and 3-D fast inflow with steady-state precession (3-D-FISP) images for the visualization of neurovascular compression in patients with trigeminal neuralgia. METHODS Twenty-four consecutive patients with trigeminal neuralgia underwent preoperative 3-D-FISP and 3-D-CISS imaging. 3-D reconstruction of nerves and vessels was performed with the use of a volume-rendering method. We compared the 3-D reconstructed images with intraoperative findings. RESULTS 3-D-CISS and 3-D-FISP images scanned from the same position clearly delineated the trigeminal nerve and vessels. 3-D reconstructed images showed the spatial relationship between the trigeminal nerve and causative vessels. The responsible arteries were identified from the 3-D reconstructed images, which closely simulated the microscopic operative view. CONCLUSION 3-D reconstructions from two types of high-resolution magnetic resonance images (3-D-CISS and 3-D-FISP) are very useful for creating preoperative simulations and in deciding whether to perform surgery in patients with trigeminal neuralgia.

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