J Neurol Surg A Cent Eur Neurosurg 2012; 73 - P049
DOI: 10.1055/s-0032-1316251

Preoperative Planning of Trigeminal Nerve Microvascular Decompression with Multimodality Data in a Stereoscopic Workspace

C. Serra 1, P. Picozzi 2, A. Franzin 2, P. Mortini 2, O. Bozinov 1, N. Krayenbühl 1, R. L. Bernays 1, R. A. Kockro 1
  • 1Klinik für Neurochirurgie, UniversitätsSpital Zürich, Zürich, Switzerland
  • 2Reparto di neurochirurgia e Gamma Knife, IRCCS San Raffaele, Milano, Italy

Aim: Preoperative detection of a neurovascular conflict in case of trigeminal neuralgia (TN) can facilitate therapeutic decision-making and surgical planning. For this purpose the quality of neuroradiological imaging and its visualization is important. Thus, we present our experiences with preoperative, stereoscopic, multimodality simulation of the anatomy of the trigeminal nerve root and its surrounding vasculature with reconstructed magnetic resonance cisternography (T2-3D-DRIVE) and contrast-enhanced magnetic resonance angiography (MRA) and magnetic resonance venography (MRV).

Methods: In this study we included 15 patients with TN. T2-3D-DRIVE and MRA/MRV series were fused and three-dimensionally reconstructed in a virtual reality environment (Dextroscope). The trigeminal nerve, surrounding arterial and venous vasculature, brainstem surface, and the transverse and sigmoid sinus were segmented in all cases. The conflict between nerve and vasculature was visualized and retrosigmoid approaches with varying trajectories were simulated and compared with the intraoperative findings.

Results: The mean imaging processing time was 30 to 40 minutes. In all patients the superior cerebellar artery was the offending vessel. The preoperative simulations enabled a clear understanding of the course of the offending vasculature from a surgical viewpoint and accurate anticipation of the individually required dissection while taking into account surrounding structural constraints. Intraoperatively the target area proved to be consistent with preoperative findings in all cases and the microvascular decompression could be performed as planned.

Conclusion: Current imaging technology allows detailed preoperative visualization of the pathoanatomical spatial relationships in cases of TN. The Dextroscope allows establishing a clear dissection and decompression strategy resulting in save and straightforward vascular decompression.