Samer Zawy Alsofy1,2, Heinz Welzel Saravia3, Makoto Nakamura4, Christian Ewelt3, Marc Lewitz3, Ioanna Sakellaropoulou3, Hraq Mourad Sarkis3, Thomas Fortmann3, Stephanie Schipmann5, Eric Suero Molina5, Antonio Santacroce3,6, Asem Salma7, Ralf Stroop8. 1. Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany. SZawyAlsofy@barbaraklinik.de. 2. Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Germany. SZawyAlsofy@barbaraklinik.de. 3. Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Germany. 4. Department of Neurosurgery, Academic Hospital Köln-Merheim, Witten/Herdecke University, Köln, Germany. 5. Department of Neurosurgery, University Hospital Münster, Münster, Germany. 6. Department of Neurosurgery, Eberhard-Karls-University, Tübingen, Germany. 7. Department of Neurosurgery, St. Rita's Neuroscience Institute, Lima, Ohio, USA. 8. Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany.
Abstract
OBJECTIVE: Trigeminal neuralgia (TN) is a lightning bolt of violent, electrifying, and stinging pain, often secondary to the neurovascular conflict (NVC). The vessels involved in NVC are mostly arteries and rarely veins. Evaluation of NVC in the deep infratentorial region is inseparably connected with cranial imaging. We retrospectively analyzed the potential influence of three-dimensional (3D) virtual reality (VR) reconstructions compared to conventional magnetic resonance imaging (MRI) scans on the evaluation of NVC for the surgical planning of microvascular decompression in patients with TN. METHODS: Medical files were retrospectively analyzed regarding patient- and disease-related data. Preoperative MRI scans were retrospectively visualized via VR software to detect the characteristics of NVC. A questionnaire of experienced neurosurgeons evaluated the influence of VR visualization technique on identification of anatomical structures involved in NVC and on surgical strategy. RESULTS: Twenty-four patients were included and 480 answer sheets were evaluated. Compared to conventional MRI, image presentation using 3D-VR modality significantly influenced the identification of the affected trigeminal nerve (p = 0.004), the vascular structure involved in the NVC (p = 0.0002), and the affected side of the trigeminal nerve (p = 0.005). CONCLUSIONS: In patients with TN caused by NVC, the reconstruction of conventional preoperative MRI scans and the spatial and anatomical presentation in 3D-VR models offers the possibility of increased understanding of the anatomy and even more the underlying pathology, and thus influences operation planning and strategy.
OBJECTIVE: Trigeminal neuralgia (TN) is a lightning bolt of violent, electrifying, and stinging pain, often secondary to the neurovascular conflict (NVC). The vessels involved in NVC are mostly arteries and rarely veins. Evaluation of NVC in the deep infratentorial region is inseparably connected with cranial imaging. We retrospectively analyzed the potential influence of three-dimensional (3D) virtual reality (VR) reconstructions compared to conventional magnetic resonance imaging (MRI) scans on the evaluation of NVC for the surgical planning of microvascular decompression in patients with TN. METHODS: Medical files were retrospectively analyzed regarding patient- and disease-related data. Preoperative MRI scans were retrospectively visualized via VR software to detect the characteristics of NVC. A questionnaire of experienced neurosurgeons evaluated the influence of VR visualization technique on identification of anatomical structures involved in NVC and on surgical strategy. RESULTS: Twenty-four patients were included and 480 answer sheets were evaluated. Compared to conventional MRI, image presentation using 3D-VR modality significantly influenced the identification of the affected trigeminal nerve (p = 0.004), the vascular structure involved in the NVC (p = 0.0002), and the affected side of the trigeminal nerve (p = 0.005). CONCLUSIONS: In patients with TN caused by NVC, the reconstruction of conventional preoperative MRI scans and the spatial and anatomical presentation in 3D-VR models offers the possibility of increased understanding of the anatomy and even more the underlying pathology, and thus influences operation planning and strategy.
Authors: Ali Alaraj; Cristian J Luciano; Daniel P Bailey; Abdussalam Elsenousi; Ben Z Roitberg; Antonio Bernardo; P Pat Banerjee; Fady T Charbel Journal: Neurosurgery Date: 2015-03 Impact factor: 4.654