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.
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.
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).
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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We thank Dr. Lidmila Fuskova for assistance with statistical analysis. The manuscript was proofread for English language by Deborah Nock (Medical WriteAway, Norwich, UK).
No funding was received for this research.
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).
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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 (2021). https://doi.org/10.1007/s10143-021-01500-w
- Microvascular decompression
- Neurovascular conflict
- Surgical planning
- Trigeminal neuralgia
- Three-dimensional reconstruction
- Virtual reality