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Virtual reality-based evaluation of neurovascular conflict for the surgical planning of microvascular decompression in trigeminal neuralgia patients

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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.

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Acknowledgements

We thank Dr. Lidmila Fuskova for assistance with statistical analysis. The manuscript was proofread for English language by Deborah Nock (Medical WriteAway, Norwich, UK).

Funding

No funding was received for this research.

Author information

Authors and Affiliations

  1. Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany

    Samer Zawy Alsofy & Ralf Stroop

  2. Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Germany

    Samer Zawy Alsofy, Heinz Welzel Saravia, Christian Ewelt, Marc Lewitz, Ioanna Sakellaropoulou, Hraq Mourad Sarkis, Thomas Fortmann & Antonio Santacroce

  3. Department of Neurosurgery, Academic Hospital Köln-Merheim, Witten/Herdecke University, Köln, Germany

    Makoto Nakamura

  4. Department of Neurosurgery, University Hospital Münster, Münster, Germany

    Stephanie Schipmann & Eric Suero Molina

  5. Department of Neurosurgery, Eberhard-Karls-University, Tübingen, Germany

    Antonio Santacroce

  6. Department of Neurosurgery, St. Rita’s Neuroscience Institute, Lima, Ohio, USA

    Asem Salma

Authors
  1. Samer Zawy Alsofy
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  2. Heinz Welzel Saravia
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  4. Christian Ewelt
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  12. Asem Salma
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  13. Ralf Stroop
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Samer Zawy Alsofy, Heinz Welzel Saravia, and Ioanna Sakellaropoulou. The first draft of the manuscript was written by Samer Zawy Alsofy, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Samer Zawy Alsofy.

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Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the ethics commission of the Medical Faculty, Witten/Herdecke University (Ref-Nr. 201/2018).

Human and animal experiments

This article does not contain any studies with humans or animals performed by any of the authors.

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The ethics commission of the Medical Faculty, Witten/Herdecke University (Ref-Nr. 201/2018) confirmed that formal consent is not required for this retrospective study.

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Zawy Alsofy, S., Welzel Saravia, H., Nakamura, M. et al. Virtual reality-based evaluation of neurovascular conflict for the surgical planning of microvascular decompression in trigeminal neuralgia patients. Neurosurg Rev 44, 3309–3321 (2021). https://doi.org/10.1007/s10143-021-01500-w

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