PREOPERATIVE SIMULATION FOR MICROVASCULAR DECOMPRESSION IN PATIENTS WITH IDIOPATHIC TRIGEMINAL NEURALGIA: VISUALIZATION WITH THREE‐DIMENSIONAL MAGNETIC RESONANCE CISTERNOGRAM AND ANGIOGRAM FUSION IMAGING

OBJECTIVEPrecise assessment of the complex nerve-vessel relationship at the root entry zone of the trigeminal nerve is useful for planning microvascular decompression in patients with idiopathic trigeminal neuralgia. We have applied a fusion imaging technique of three-dimensional (3-D) magnetic resonance cisternography and co-registered 3-D magnetic resonance angiography (MRA) that allows virtual reality for the preoperative simulation of the neurovascular conflict at the trigeminal nerve root entry zone. METHODSFusion images of 3-D magnetic resonance cisternograms and angiograms were reconstructed by a perspective volume-rendering algorithm from the volumetric data sets of magnetic resonance cisternography, obtained by a T2-weighted 3-D fast spin echo sequence, and co-registered MRA, by a 3-D time-of-flight sequence. Consecutive series of 12 patients with idiopathic trigeminal neuralgia were studied with fusion 3-D magnetic resonance cisternogram and MRA in the preoperative assessment for the microvascular decompression of the affected trigeminal nerve. RESULTSThe complex anatomical relationship of the offending vessels to the trigeminal nerve root entry zone was depicted on the fusion 3-D magnetic resonance cisternogram and MRA. The presence of offending vessels and compressive site of neurovascular conflict was assessed from the various viewpoints within the cistern and was presumed by the preoperative simulation through the surgical access (surgeon's-eye view). The blinded surgical trajectory was discerned by the virtual image through the opposite direction projected from above (bird's-eye view). The 3-D visualization of the nerve-vessel relationship with fusion images was consistent with the intraoperative trajectory and findings. CONCLUSIONFusion imaging of 3-D magnetic resonance cisternogram and MRA may prove a useful adjunct for the diagnosis and decision-making process to execute the microvascular decompression in patients with idiopathic trigeminal neuralgia.

[1]  K. Burchiel,et al.  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 , 2006, Neurosurgery.

[2]  I. Date,et al.  Differential diagnosis of the infundibular dilation and aneurysm of internal carotid artery: assessment with fusion imaging of 3D MR cisternography/angiography. , 2006, AJNR. American journal of neuroradiology.

[3]  Keisuke Onoda,et al.  Influence of perianeurysmal environment on the deformation and bleb formation of the unruptured cerebral aneurysm: assessment with fusion imaging of 3D MR cisternography and 3D MR angiography. , 2005, AJNR. American journal of neuroradiology.

[4]  Timothy D Solberg,et al.  Three-dimensional Fast Imaging Employing Steady-state Acquisition Magnetic Resonance Imaging for Stereotactic Radiosurgery of Trigeminal Neuralgia , 2005, Neurosurgery.

[5]  I. Date,et al.  Visualization of aneurysmal contours and perianeurysmal environment with conventional and transparent 3D MR cisternography. , 2005, AJNR. American journal of neuroradiology.

[6]  Indra Yousry,et al.  Detailed anatomy of the motor and sensory roots of the trigeminal nerve and their neurovascular relationships: a magnetic resonance imaging study. , 2004, Journal of neurosurgery.

[7]  Bernd Tomandl,et al.  Three-dimensional visualization of neurovascular relationships in the posterior fossa: technique and clinical application. , 2004, Journal of neurosurgery.

[8]  K. Tsuchiya,et al.  Evaluation of MR cisternography of the cerebellopontine angle using a balanced fast-field-echo sequence: preliminary findings , 2004, European Radiology.

[9]  Dirk De Ridder,et al.  Functional Anatomy of the Human Cochlear Nerve and Its Role in Microvascular Decompressions for Tinnitus , 2004, Neurosurgery.

[10]  Tooru Inoue,et al.  Microvascular Decompression for Treatment of Trigeminal Neuralgia, Hemifacial Spasm, and Glossopharyngeal Neuralgia: Three Surgical Approach Variations: Technical Note , 2003, Neurosurgery.

[11]  K. Burchiel.  A New Classification for Facial Pain , 2003, Neurosurgery.

[12]  H. Bruhn,et al.  Vascular compression in glossopharyngeal neuralgia: demonstration by high-resolution MRI at 3 tesla , 2003, Neuroradiology.

[13]  Tohru Kurabayashi,et al.  Trigeminal neuralgia: evaluation of neuralgic manifestation and site of neurovascular compression with 3D CISS MR imaging and MR angiography. , 2003, Radiology.

[14]  Keisuke Onoda,et al.  Visualization of intraaneurysmal flow patterns with transluminal flow images of 3D MR angiograms in conjunction with aneurysmal configurations. , 2003, AJNR. American journal of neuroradiology.

[15]  T. Nagaoka,et al.  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 , 2002, Neurosurgery.

[16]  M. Ishikawa,et al.  Operative findings in cases of trigeminal neuralgia without vascular compression: proposal of a different mechanism , 2002, Journal of Clinical Neuroscience.

[17]  Qing Bai,et al.  Single-unit neural recording with active microelectrode arrays , 2001, IEEE Transactions on Biomedical Engineering.

[18]  T. Ishigaki,et al.  MR cisternography of the cerebellopontine angle: comparison of three-dimensional fast asymmetrical spin-echo and three-dimensional constructive interference in the steady-state sequences. , 2001, AJNR. American journal of neuroradiology.

[19]  H. Jäger,et al.  Contrast-enhanced MR angiography of intracranial giant aneurysms. , 2000, AJNR. American journal of neuroradiology.

[20]  A. Rhoton,et al.  The cerebellopontine angle and posterior fossa cranial nerves by the retrosigmoid approach. , 2000, Neurosurgery.

[21]  H. Isoda,et al.  Magnetic resonance cisternography used to determine precise topography of the facial nerve and three components of the eighth cranial nerve in the internal auditory canal and cerebellopontine cistern. , 1999, Journal of neurosurgery.

[22]  O. Okuda,et al.  Delineation of small nerves and blood vessels with three-dimensional fast spin-echo MR imaging: comparison of presurgical and surgical findings in patients with hemifacial spasm. , 1998, AJNR. American journal of neuroradiology.

[23]  I Muro,et al.  Magnetic resonance cisternography for visualization of intracisternal fine structures. , 1998, Journal of neurosurgery.

[24]  D. Ross,et al.  Magnetic resonance evaluation of ventrolateral medullary compression in essential hypertension. , 1998, Journal of neurosurgery.

[25]  S. Sheppard,et al.  T2-weighted three-dimensional turbo spin-echo MR of intracranial aneurysms. , 1997, AJNR. American journal of neuroradiology.

[26]  P. Jannetta.  Observations on the Etiology of Trigeminal Neuralgia, Hemifacial Spasm, Acoustic Nerve Dysfunction and Glossopharyngeal Neuralgia. Definitive Microsurgical Treatment and Results in 117 Patients* , 1977, Neurochirurgia.

[27]  P. Jannetta,et al.  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. , 2003, Neurosurgery.

[28]  M. Sindou,et al.  Anatomical Observations During Microvascular Decompression for Idiopathic Trigeminal Neuralgia (with Correlations Between Topography of Pain and Site of the Neurovascular Conflict). Prospective Study in a Series of 579 Patients , 2002, Acta Neurochirurgica.

[29]  P. Stoeter,et al.  Sensitivity and specificity of MRA in the diagnosis of neurovascular compression in patients with trigeminal neuralgia. A correlation of MRA and surgical findings. , 1998, Neuroradiology.