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Journal of Neurorestoratology  2020, Vol. 8 Issue (2): 104-113    doi: 10.26599/JNR.2020.9040005
Research Article     
Preoperative visualization of neurovascular contact with 3D-FIESTA combined with 3D-TOF MRA to guide microvascular decompression surgery planning
Dezhong Liu, Pengfei Shi, Kai Li, Yazhou Guo, Xiao Liu, Changwei Wang, Yu Liu, Bing He, Xiaoyang Zhang*
Department of Neurosurgery, Zhoukou Central Hospital, Zhoukou 466000, Henan, China
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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.



Key wordsmicrovascular decompression      trigeminal neuralgia      hemifacial spasm      3D-FIESTA      3D-TOF MRA     
Received: 12 January 2020      Published: 04 July 2020
Corresponding Authors: Xiaoyang Zhang   
Cite this article:

Dezhong Liu, Pengfei Shi, Kai Li, Yazhou Guo, Xiao Liu, Changwei Wang, Yu Liu, Bing He, Xiaoyang Zhang. Preoperative visualization of neurovascular contact with 3D-FIESTA combined with 3D-TOF MRA to guide microvascular decompression surgery planning. Journal of Neurorestoratology, 2020, 8: 104-113.

URL:

http://jnr.tsinghuajournals.com/10.26599/JNR.2020.9040005     OR     http://jnr.tsinghuajournals.com/Y2020/V8/I2/104

Fig. 1MRI of a patient with trigeminal neuralgia caused by an artery. (A) and (B) Axial images show the relationship between the trigeminal nerve and vessel in 3D-FIESTA and 3D-TOF MRA (a1, b1: trigeminal nerve; a2, b2: AICA). (C) to (F) MPR images show the relationship between the trigeminal nerve and vessel (c1, d1, e1, f1: trigeminal nerve; c2, d2, e2, f2: AICA).
Responsible vesselsPreoperative (using MRI)Coincidence with intraoperativeAccuracy
SCA454191.1%
AICA453577.8%
PICA131076.9%
Multiple vessels10330.0%
Table 1Accuracy of the preoperative and intraoperative results among different responsible vascular vessels.
DiseasePreoperative (using MRI)Coincidence with intraoperativeAccuracy
abcdabcdabcd
TN397343721194.9%28.6%33.3%25.0%
HFS6381064339266.7%86.8%90.0%33.3%
Table 2Accuracy between the preoperative and intraoperative results among different responsible blood vessels in TN and HFS.
GroupPreoperative (using MRI)Coincidence with intraoperativeAccuracyχ2 Test P value
Gender????
?Male493775.5%?
?Female645281.2%0.305
Disease side????
?Left503978.0%?
?Right635079.0%0.520
Disease duration????
?≤ 1 year151280.0%?
?> 1 year987778.6%0.602
Disease Type????
?TN534177.4%?
?HFS604880.0%0.454
Table 3Accuracy between the preoperative and intraoperative results among different genders, disease durations, disease sides, and disease types.
FactorCorrelation coefficientVarianceP value
Gender0.6560.4580.152
Disease side0.2690.4610.560
Disease duration0.0410.040.307
Disease type0.0570.4540.901
Table 4Correlation of the accuracy with gender, disease duration, disease side, and disease type.
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