Sensitivity of high-resolution three-dimensional magnetic resonance angiography and three-dimensional spoiled-gradient recalled imaging in the prediction of neurovascular compression in patients with hemifacial spasm

2009 ◽  
Vol 111 (4) ◽  
pp. 733-736 ◽  
Author(s):  
Ahmed M. Raslan ◽  
Reynaldo DeJesus ◽  
Caglar Berk ◽  
Andrew Zacest ◽  
Jim C. Anderson ◽  
...  
Keyword(s):  
High Resolution ◽  
Trigeminal Neuralgia ◽  
Blood Vessels ◽  
Hemifacial Spasm ◽  
Predictive Value ◽  
Mr Angiography ◽  
Three Dimensional ◽  
Vascular Compression ◽  
Neurovascular Compression ◽  
Predictive Values

Object Hemifacial spasm is a clinical syndrome caused by vascular compression of the facial nerve in the cerebellopontine angle, which can be relieved by surgical intervention. Advances in medical imaging technology allow for direct visualization of the offending blood vessels in hemifacial spasm and similar conditions (such as trigeminal neuralgia). The utility of high resolution 3D MR angiography and 3D spoiled-gradient recalled (SPGR) imaging sequences for surgical decision-making in hemifacial spasm, as measured by sensitivity, specificity, and positive and negative predictive values, has not been previously determined. Methods A retrospective review was undertaken of 23 patients with hemifacial spasm who underwent operations between January 2001 and December 2006 at Oregon Health & Science University. All patients underwent preoperative high-resolution 3D MR angiography and 3D SPGR imaging. The sensitivity of the SPGR imaging/MR angiography interpretation of neurovascular compression (NVC) by both a neurosurgeon and 2 neuroradiologists was determined in relation to the presence of actual NVC during surgery. Results All patients were found to have NVC at surgery. After review by a neurosurgeon and 2 neuroradiologists, imaging data from 19 of the 23 patients were evaluated. The neurosurgeon's interpretation had a sensitivity of 79% and a positive predictive value (PPV) of 100%. The first neuroradiologist's interpretation had a sensitivity of 21% with a PPV of 100%. Further interpretation by a blinded second neuroradiologist with expertise in MR imaging of hemifacial spasm and trigeminal neuralgia was conducted, and sensitivity was 59% and PPV was 100%. Specificity was not determined because there were no true negative cases. The negative predictive value was 0% for both the neurosurgeon's and neuroradiologists' evaluations. Conclusions Although high-resolution 3D MR angiography and 3D SPGR imaging was helpful in providing information about the anatomical relationship of cranial nerve VII and surrounding blood vessels, the authors determined that in the case of hemifacial spasm these types of imaging did not influence preoperative surgical decisionmaking.

High-resolution Three-dimensional Magnetic Resonance Angiography and Three-dimensional Spoiled Gradient-recalled Imaging in the Evaluation of Neurovascular Compression in Patients with Trigeminal Neuralgia: A Double-blind Pilot Study

Neurosurgery ◽  
2006 ◽  
Vol 58 (4) ◽  
pp. 666-673 ◽  
Author(s):  
Valerie C. Anderson ◽  
Phillip C. Berryhill ◽  
Michael A. Sandquist ◽  
David P. Ciaverella ◽  
Gary M. Nesbit ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
High Resolution ◽  
Trigeminal Neuralgia ◽  
Mr Angiography ◽  
Three Dimensional ◽  
Decompression Surgery ◽  
Neurovascular Compression ◽  
Good Sensitivity ◽  
Double Blind ◽  
Microvascular Decompression Surgery

Abstract OBJECTIVE: To assess the value of high-resolution three-dimensional (3D) time-of-flight (TOF) magnetic resonance (MR) angiography and gadolinium (Gad)-enhanced 3D spoiled gradient-recalled imaging in the visualization of neurovascular compression in patients with trigeminal neuralgia. METHODS: Forty-eight patients with unilateral trigeminal neuralgia underwent high-resolution 3D TOF MR angiography. After administration of a contrast agent, a 3D spoiled gradient-recalled sequence (3D Gad) was run. Images were reviewed by a radiologist blinded to clinical details. All patients underwent microvascular decompression surgery. Microdissection of the trigeminal nerve and compressing vessels was videotaped during surgery and reviewed by surgeons uninvolved in patient care. Results from neuroradiological studies were then compared with findings on operative videotapes. RESULTS: MR angiography in combination with 3D Gad imaging identified surgically verified neurovascular contact in 42 of 46 (91%) symptomatic nerves. The offending vessel (artery, vein) was correctly identified in 31 of 41 cases (sensitivity, 76%; specificity, 75%). Neurovascular compression was observed in 71% of asymptomatic nerves with a trend toward greater compression severity on the symptomatic nerve (P < 0.09). Agreement between the direction of neurovascular contact defined by 3D TOF MR angiography and 3D Gad and findings at surgery was good (κ = 0.78; 95% confidence interval, 0.61–0.94). CONCLUSION: Double-blind assessment of surgical and neuroradiological findings confirms that neurovascular compression can be visualized with good sensitivity in patients with trigeminal neuralgia by 3D TOF MR angiography in combination with Gad-enhanced 3D spoiled gradient-recalled sequences. Anatomic relationships defined by this method can be useful in predicting surgical findings.

Cranial nerve vascular compression syndromes

2019 ◽  
pp. 909-928
Author(s):  
Marc Sindou ◽  
George Georgoulis
Keyword(s):  
High Resolution ◽  
Trigeminal Neuralgia ◽  
Cranial Nerve ◽  
Clinical Manifestations ◽  
Ventrolateral Medulla ◽  
Vascular Compression ◽  
Neurovascular Compression ◽  
Mri Imaging ◽  
Neurovascular Conflict ◽  
Vestibulocochlear Nerve

Hyperactive cranial nerve syndromes originate in a large number of cases from chronic neurovascular conflict. Classical trigeminal neuralgia is the most frequent syndrome, followed by primary hemifacial spasm. Vago-glossopharyngeal neuralgia is rare, but still underestimated. Vascular compression of the vestibulocochlear nerve may be at the origin of tinnitus and positional disabling vertigo. Vascular compression of the ventrolateral medulla can be a possible cause of neurogenic essential blood hypertension. Chronic pulsatile neurovascular compression would generate ectopic stimuli that are transmitted to neighbouring fibres through focal zones of demyelination, which provokes an ephaptic mechanism between fibres. Also, chronic pulsatile compression would induce hyperactivity of the corresponding cranial nerve nuclei. In trigeminal neuralgia this hyperactivity is expressed by epileptic-like clinical manifestations that respond to anticonvulsants. MRI imaging with high-resolution protocol, and the three following sequences—3D T2 high-resolution, TOF MR-angiography, and T1 with gadolinium—permit to depict the neurovascular conflict and predict the degree of compression. First option of the treatment is microvascular decompression.

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.

Three-dimensional-MRI of neurovascular compression in patients with hemifacial spasm

1995 ◽  
Vol 37 (5) ◽  
pp. 350-352 ◽  
Author(s):  
T. Hosoya ◽  
N. Watanabe ◽  
K. Yamaguchi ◽  
S. Saito ◽  
O. Nakai
Keyword(s):  
Hemifacial Spasm ◽  
Three Dimensional ◽  
Neurovascular Compression

Endoscopic-Assisted Microvascular Decompression

2018 ◽  
pp. 139-154
Author(s):  
M. Yashar S. Kalani ◽  
Michael R. Levitt ◽  
Celene B. Mulholland ◽  
Charles Teo ◽  
Peter Nakaji
Keyword(s):  
Trigeminal Neuralgia ◽  
Minimally Invasive ◽  
Effective Treatment ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Patient Population ◽  
Surgical Intervention ◽  
Cranial Nerves ◽  
Vascular Compression ◽  
Ephaptic Transmission

Diseases of ephaptic transmission are commonly caused by vascular compression of cranial nerves. The advent of microvascular decompression has allowed for surgical intervention for this patient population. This chapter highlights the technique of endoscopic-assisted microvascular decompression for trigeminal neuralgia and hemifacial spasm. Endoscopy and keyhole techniques have resulted in a minimally invasive and effective treatment of symptoms for patients with neuralgia.

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