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1
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Wang F, Ma A, Wu Z, Xie M, Lun P, Sun P. Development and validation of radiomics models for the prediction of diagnosis of classic trigeminal neuralgia. Front Neurosci 2023; 17:1188590. [PMID: 37877009 PMCID: PMC10591183 DOI: 10.3389/fnins.2023.1188590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 09/18/2023] [Indexed: 10/26/2023] Open
Abstract
The study aims to develop a magnetic resonance imaging (MRI)-based radiomics model for the diagnosis of classic trigeminal neuralgia (cTN). This study involved 350 patients with cTN and 100 control participants. MRI data were collected retrospectively for all the enrolled subjects. The symptomatic side trigeminal nerve regions of patients and both sides of the trigeminal nerve regions of control participants were manually labeled on MRI images. Radiomics features of the areas labeled were extracted. Principle component analysis (PCA) and least absolute shrinkage and selection operator (LASSO) regression were utilized as the preliminary feature reduction methods to decrease the high dimensionality of radiomics features. Machine learning methods were established, including LASSO logistic regression, support vector machine (SVM), and Adaboost methods, evaluating each model's diagnostic abilities using 10-fold cross-validation. All the models showed excellent diagnostic ability in predicting trigeminal neuralgia. A prospective study was conducted, 20 cTN patients and 20 control subjects were enrolled to validate the clinical utility of all models. Results showed that the radiomics models based on MRI can predict trigeminal neuralgia with high accuracy, which could be used as a diagnostic tool for this disorder.
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Affiliation(s)
- Fuxu Wang
- Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Anbang Ma
- Shanghai Xunshi Technology Co., Ltd., Shanghai, China
| | - Zeyu Wu
- Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Mingchen Xie
- Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Peng Lun
- Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Peng Sun
- Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao, China
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Wang J, Zhang W, Wang X, Luo T, Wang X, Qu Y. Application of Neuronavigation in Microvascular Decompression: Optimizing Craniotomy and 3D Reconstruction of Neurovascular Compression. J Craniofac Surg 2023; 34:e620-e623. [PMID: 37280732 DOI: 10.1097/scs.0000000000009388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/26/2023] [Indexed: 06/08/2023] Open
Abstract
OBJECT Microvascular decompression (MVD) is the best curative treatment for trigeminal neuralgia and hemifacial spasm. We used the neuronavigation to reconstruct the 3D image of cranial nerve and blood vessel to identify the neurovascular compression, and to reconstruct the venous sinus and skull to optimize craniotomy. PATIENTS AND METHODS A total of 11 trigeminal neuralgia and 12 hemifacial spasm cases were selected. All patients had preoperative MRI which included 3D Time of Flight (3D-TOF), Magnetic Resonance Venography (MRV) and computer tomography (CT) for navigation. Imaging sequences were fused and reconstructed by navigation system before operation. The 3D-TOF images were used to delineate cranial nerve and vessel. The CT and MRV images were used to mark transverse sinus and the sigmoid sinus for craniotomy. All patients underwent MVD and have the preoperative view compared with intraoperative findings. RESULTS Approaching to the cerebellopontine angle right after opening the dura and got no cerebellar retracion or petrosal vein rupture during craniotomy. Ten of 11 trigeminal neuralgia and all 12 hemifacial spasm patients got excellent preoperative 3D reconstruction fusion images, which were also confirmed by intraoperative findings. All 11 trigeminal neuralgia patients and 10 of 12 hemifacial spasm patients were symptom free without any neurological complications just after the surgery. Other 2 hemifacial spasm patients got delayed resolution in 2 months after surgery. CONCLUSIONS Through the neuronavigation guided craniotomy and the 3D neurovascular reconstruction, surgeons can better identify the compression of nerve and blood vessel, and reduce complications.
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Affiliation(s)
- Jing Wang
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Wei Zhang
- Department of Neurosurgery, First Affiliated Hospital of Xi 'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xin Wang
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Tian Luo
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Xuelian Wang
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Yan Qu
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, China
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Liang C, Yang L, Reichardt W, Zhang B, Li R. Different MRI-based methods for the diagnosis of neurovascular compression in trigeminal neuralgia or hemifacial spasm: A network meta-analysis. J Clin Neurosci 2023; 108:19-24. [PMID: 36577319 DOI: 10.1016/j.jocn.2022.12.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/14/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Accurate preoperative diagnosis of neurovascular compression (NVC) is crucial in the treatment of trigeminal neuralgia (TN) or hemifacial spasm (HFS). At present, there are many magnetic resonance imaging (MRI)-based methods for diagnosing NVC in clinical practice. This network meta-analysis (NMA) aimed to evaluate the diagnostic performance of different MRI-based imaging methods for NVC in patients with TN and HFS. MATERIALS AND METHODS Related studies based on a search of PubMed, Embase, Web of Science and the Cochrane Library were retrieved. A two-way analysis of variance model was constructed for the Bayesian NMA to compare the performance of different diagnostic imaging methods. RESULTS Our search identified 595 articles, of which 26 studies (including 2085 patients) related to 4 diagnostic imaging methods (3D time-of-flight magnetic resonance angiography (3D TOF MRA), high resolution T2-weighted imaging (HR T2WI), 3D TOF MRA combined with HR T2WI, and 3D multimodal image fusion (MIF) based on 3D TOF MRA combined with HR T2WI) were included in this NMA. The results showed that 3D MIF based on 3D TOF MRA combined with HR T2WI had the highest related sensitivity, the highest superiority index and the largest area under the receiver operating characteristic curve among all the methods. CONCLUSIONS 3D MIF based on 3D TOF MRA combined with HR T2WI had better diagnostic performance for detecting NVC in patients with TN or HSF than other MRI-based imaging methods. This method can be used as an effective tool for preoperative evaluation of MVD.
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Affiliation(s)
- Chen Liang
- Department of Neurosurgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China; Department of Radiology Medical Physics, University Medical Center Freiburg, University of Freiburg, Freiburg 79106, Germany.
| | - Ling Yang
- Department of Aviation Psychology Research, Xi'an Civil Aviation Hospital, Xi'an 710082, Shaanxi Province, China
| | - Wilfried Reichardt
- Department of Radiology Medical Physics, University Medical Center Freiburg, University of Freiburg, Freiburg 79106, Germany
| | - Binbin Zhang
- Department of Neurosurgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Ruichun Li
- Department of Neurosurgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
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4
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Liang C, Yang L, Zhang BB, Guo SW, Li RC. Three-dimensional time-of-flight magnetic resonance angiography combined with high resolution T2-weighted imaging in preoperative evaluation of microvascular decompression. World J Clin Cases 2022; 10:12594-12604. [PMID: 36579121 PMCID: PMC9791536 DOI: 10.12998/wjcc.v10.i34.12594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/29/2022] [Accepted: 11/08/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Neurovascular compression (NVC) is the main cause of primary trigeminal neuralgia (TN) and hemifacial spasm (HFS). Microvascular decompression (MVD) is an effective surgical method for the treatment of TN and HFS caused by NVC. The judgement of NVC is a critical step in the preoperative evaluation of MVD, which is related to the effect of MVD treatment. Magnetic resonance imaging (MRI) technology has been used to detect NVC prior to MVD for several years. Among many MRI sequences, three-dimensional time-of-flight magnetic resonance angiography (3D TOF MRA) is the most widely used. However, 3D TOF MRA has some shortcomings in detecting NVC. Therefore, 3D TOF MRA combined with high resolution T2-weighted imaging (HR T2WI) is considered to be a more effective method to detect NVC.
AIM To determine the value of 3D TOF MRA combined with HR T2WI in the judgment of NVC, and thus to assess its value in the preoperative evaluation of MVD.
METHODS Related studies published from inception to September 2022 based on PubMed, Embase, Web of Science, and the Cochrane Library were retrieved. Studies that investigated 3D TOF MRA combined with HR T2WI to judge NVC in patients with TN or HFS were included according to the inclusion criteria. Studies without complete data or not relevant to the research topics were excluded. The Quality Assessment of Diagnostic Accuracy Studies checklist was used to assess the quality of included studies. The publication bias of the included literature was examined by Deeks’ test. An exact binomial rendition of the bivariate mixed-effects regression model was used to synthesize data. Data analysis was performed using the MIDAS module of statistical software Stata 16.0. Two independent investigators extracted patient and study characteristics, and discrepancies were resolved by consensus. Individual and pooled sensitivities and specificities were calculated. The I² statistic and Q test were used to test heterogeneity. The study was registered on the website of PROSERO (registration No. CRD42022357158).
RESULTS Our search identified 595 articles, of which 12 (including 855 patients) fulfilled the inclusion criteria. Bivariate analysis showed that the pooled sensitivity and specificity of 3D TOF MRA combined with HR T2WI for detecting NVC were 0.96 [95% confidence interval (CI): 0.92-0.98] and 0.92 (95%CI: 0.74-0.98), respectively. The pooled positive likelihood ratio was 12.4 (95%CI: 3.2-47.8), pooled negative likelihood ratio was 0.04 (95%CI: 0.02-0.09), and pooled diagnostic odds ratio was 283 (95%CI: 50-1620). The area under the receiver operating characteristic curve was 0.98 (95%CI: 0.97-0.99). The studies showed no substantial heterogeneity (I2= 0, Q = 0.001 P = 0.50).
CONCLUSION Our results suggest that 3D TOF MRA combined with HR T2WI has excellent sensitivity and specificity for judging NVC in patients with TN or HFS. This method can be used as an effective tool for preoperative evaluation of MVD.
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Affiliation(s)
- Chen Liang
- Department of Neurosurgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
- Department of Radiology Medical Physics, University Medical Center Freiburg, University of Freiburg, Freiburg 79108, Germany
| | - Ling Yang
- Department of Aviation Psychology Research, Xi’an Civil Aviation Hospital, Xi’an 710082, Shaanxi Province, China
| | - Bin-Bin Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Shi-Wen Guo
- Department of Neurosurgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Rui-Chun Li
- Department of Neurosurgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
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Three-Dimensional Constructive Interference in Steady State (3D CISS) Imaging and Clinical Applications in Brain Pathology. Biomedicines 2022; 10:biomedicines10112997. [PMID: 36428564 PMCID: PMC9687637 DOI: 10.3390/biomedicines10112997] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/14/2022] [Accepted: 11/17/2022] [Indexed: 11/23/2022] Open
Abstract
Three-dimensional constructive interference in steady state (3D CISS) is a steady-state gradient-echo sequence in magnetic resonance imaging (MRI) that has been used in an increasing number of applications in the study of brain disease in recent years. Owing to the very high spatial resolution, the strong hyperintensity of the cerebrospinal fluid signal and the high contrast-to-noise ratio, 3D CISS can be employed in a wide range of scenarios, ranging from the traditional study of cranial nerves, the ventricular system, the subarachnoid cisterns and related pathology to more recently discussed applications, such as the fundamental role it can assume in the setting of acute ischemic stroke, vascular malformations, infections and several brain tumors. In this review, after briefly summarizing its fundamental physical principles, we examine in detail the various applications of 3D CISS in brain imaging, providing numerous representative cases, so as to help radiologists improve its use in imaging protocols in daily clinical practice.
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Rath TJ, Policeni B, Juliano AF, Agarwal M, Block AM, Burns J, Conley DB, Crowley RW, Dubey P, Friedman ER, Gule-Monroe MK, Hagiwara M, Hunt CH, Jain V, Powers WJ, Rosenow JM, Taheri MR, DuChene Thoma K, Zander D, Corey AS. ACR Appropriateness Criteria® Cranial Neuropathy: 2022 Update. J Am Coll Radiol 2022; 19:S266-S303. [PMID: 36436957 DOI: 10.1016/j.jacr.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/07/2022] [Indexed: 11/27/2022]
Abstract
Cranial neuropathy can result from pathology affecting the nerve fibers at any point and requires imaging of the entire course of the nerve from its nucleus to the end organ in order to identify a cause. MRI with and without intravenous contrast is often the modality of choice with CT playing a complementary role. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Tanya J Rath
- Division Chair of Neuroradiology, Mayo Clinic Arizona, Phoenix, Arizona.
| | - Bruno Policeni
- Panel Chair; Department of Radiology Vice-Chair, University of Iowa Hospitals and Clinics, Iowa City, Iowa; President Iowa Radiological Society and ACR Councilor
| | - Amy F Juliano
- Panel Vice-Chair, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; NI-RADS committee chair
| | - Mohit Agarwal
- Froedtert Memorial Lutheran Hospital Medical College of Wisconsin, Milwaukee, Wisconsin; Fellowship Program Director
| | - Alec M Block
- Stritch School of Medicine Loyola University Chicago, Maywood, Illinois
| | - Judah Burns
- Montefiore Medical Center, Bronx, New York; Vice-Chair for Education & Residency Program Director, Montefiore Medical Center; Vice-Chair, Subcommittee on Methodology
| | - David B Conley
- Practice Director, Northwestern ENT and Rhinology Fellowship Director, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and Member, American Academy of Otolaryngology-Head and Neck Surgery
| | - R Webster Crowley
- Rush University Medical Center, Chicago, Illinois; Neurosurgery expert; Chief, Cerebrovascular and Endovascular Neurosurgery; Medical Director, Department of Neurosurgery; Surgical Director, Rush Comprehensive Stroke Center; Program Director, Endovascular Neurosurgery
| | | | - Elliott R Friedman
- University of Texas Health Science Center, Houston, Texas; Diagnostic Radiology Residency Program Director
| | - Maria K Gule-Monroe
- The University of Texas MD Anderson Cancer Center, Houston, Texas; Medical Director of Diagnostic Imaging at Houston Area Location Woodlands
| | - Mari Hagiwara
- Neuroradiology Fellowship Program Director and Head and Neck Imaging Director, New York University Langone Medical Center, New York, New York
| | | | - Vikas Jain
- MetroHealth Medical Center, Cleveland, Ohio; Medical Director, Lumina Imaging
| | - William J Powers
- University of North Carolina School of Medicine, Chapel Hill, North Carolina; American Academy of Neurology
| | - Joshua M Rosenow
- Neuroradiology Fellowship Program Director and Head and Neck Imaging Director, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - M Reza Taheri
- George Washington University Hospital, Washington, District of Columbia; Director of Neuroradiology
| | - Kate DuChene Thoma
- Director of Faculty Development Fellowship, University of Iowa Hospital, Iowa City, Iowa; Primary care physician
| | - David Zander
- Chief of Head and Neck Radiology, University of Colorado Denver, Denver, Colorado
| | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
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7
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Shi H, Li Y, Wang Y, Guo W, Zhang K, Du Y, Shi H, Qian T. The preoperative evaluation value of 3D-slicer program before microsurgical vascular decompression in patients with hemifacial spasm. Clin Neurol Neurosurg 2022; 217:107241. [DOI: 10.1016/j.clineuro.2022.107241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/28/2022] [Accepted: 04/01/2022] [Indexed: 11/24/2022]
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8
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Pham HD, Dang TH, Duong TK, Dinh TT, Bui VG, Nguyen TV, Huynh QH. Predictability of Fused 3D-T2-SPACE and 3D-TOF-MRA Images in Identifying Conflict in Trigeminal Neuralgia. J Pain Res 2021; 14:3421-3428. [PMID: 34754235 PMCID: PMC8570429 DOI: 10.2147/jpr.s331054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 10/22/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the efficacy of fused three-dimensional T2 sampling perfection with application-optimized contrasts using different flip-angle evolutions (3D-SPACE) and three-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA) sequences for detecting neurovascular compression (NVC) in patients presenting with trigeminal neuralgia (TN). Methods A prospective study was carried in 33 consecutive patients (m/f: 17/16; mean age, 56.3 ± 10.4 years) with unilateral TN confirmed NVC and consensus by two experienced radiologists on fused 3D-SPACE and 3D-TOF-MRA sequences of 3-tesla (3-T) MRI. All patients underwent microvascular decompression (MVD), using photos and video in surgery as documents compared with MRI. Both the MRI and MVD were reported for three grades (contact, compression, distortion), vessel types (artery or vein), identification of offending vessel, site (juxtapontine, cisternal, and juxtapetrous), and location (cranial, caudal, medial, lateral). Agreement between preoperative MRI visualization and surgical findings was assessed using the kappa (K) statistic. Results The k-values for the agreement were excellent for the grade of NVC (k=0.82), vessel types (k=0.78), and location of conflict (k=0.74), and good for identification of the offending vessel (0.65) and the site-affected vessel (k=0.69). Conclusion The fused D3-SPACE and 3D-TOF-MRA images are highly effective tools for the evaluation and treatment planning of NVC in TN patients.
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Affiliation(s)
- Hong Duc Pham
- Radiology Department, Saint Paul Hospital of Hanoi, Hanoi City, Vietnam.,Radiology Department, Hanoi Medical University, Hanoi City, Vietnam
| | - Thu Ha Dang
- Radiology Department, Saint Paul Hospital of Hanoi, Hanoi City, Vietnam.,Radiology Department, Hanoi Medical University, Hanoi City, Vietnam
| | - Trung Kien Duong
- Neurosurgery Department, Saint Paul Hospital of Hanoi, Hanoi City, Vietnam
| | - Trung Thanh Dinh
- Radiology Department, Saint Paul Hospital of Hanoi, Hanoi City, Vietnam
| | - Van Giang Bui
- Radiology Department, Hanoi Medical University, Hanoi City, Vietnam.,Radiology Centre, National Cancer Hospital, Hanoi City, Vietnam
| | - Tuan Vu Nguyen
- Cardiology Department, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Quang Huy Huynh
- Radiology Department, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.,Radiology Department, Trưng Vương Hospital, Ho Chi Minh City, Vietnam
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Traylor KS, Sekula RF, Eubanks K, Muthiah N, Chang YF, Hughes MA. Reply: Neurovascular compression in hemifacial spasm. Brain 2021; 144:awab339. [PMID: 34554199 DOI: 10.1093/brain/awab339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/05/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Katie S Traylor
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA 152103, USA
| | - Raymond F Sekula
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh 15313 PA, USA
| | - Komal Eubanks
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh 15313 PA, USA
| | - Nallammai Muthiah
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh 15313 PA, USA
| | - Yue-Fang Chang
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh 15313 PA, USA
| | - Marion A Hughes
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA 152103, USA
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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10
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Mespreuve M, Waked K, Collard B, De Ranter J, Vanneste F, Hendrickx B. The Usefulness of Magnetic Resonance Angiography to Analyze the Variable Arterial Facial Anatomy in an Effort to Reduce Filler-Associated Blindness: Anatomical Study and Visualization Through an Augmented Reality Application. Aesthet Surg J Open Forum 2021; 3:ojab018. [PMID: 34169278 PMCID: PMC8218598 DOI: 10.1093/asjof/ojab018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The use of soft tissue fillers for facial rejuvenation is increasing rapidly and the complications, unfortunately, follow the same path. Blindness caused by intravascular filler injections is a rare but devastating complication. Knowledge of the individual arterial anatomy may aid the injector in avoiding injecting into an artery and thus to prevent blindness. OBJECTIVES To evaluate if the use of magnetic resonance angiography (MRA) may visualize the arterial facial anatomy in a contrast- and radiation-free way and study the individual arterial variations using an augmented reality (AR) image. METHODS The individual arterial anatomy of the 3 terminal branches of the ophthalmic artery (supraorbital [SO]; supratrochlear [STr]; and dorsal nasal [DN] arteries) of 20 volunteers was studied by a 3-Tesla MRI, combining infrared (IR) facial warming and 3-dimensional time-of-flight multiple overlapping thin slab acquisition MRA. The resulting visualization of the facial arteries was shown on the patient's face through AR technology. RESULTS The MRA was able to visualize the SO in 90.0%, STr in 92.5%, and DN arteries in 75% of the examined patients, as well as numerous variations in both vessel localization and path. Furthermore, a proof-of-concept of the AR visualization of the individual arterial anatomy was successfully implemented. CONCLUSIONS Dermal filler injectors should be aware of the risk of filler-induced blindness and familiarize themselves with the visualization of the variable facial vascular anatomy. The implementation of a one-time MRA and subsequent AR visualization may be useful in the accurate planning of minimally invasive facial rejuvenation procedures.
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Affiliation(s)
- Marc Mespreuve
- Department of Medical Imaging, University Hospital Ghent, Ghent, Belgium
| | - Karl Waked
- Department of Plastic and Reconstructive Surgery, University Hospital Brussel, Brussel, Belgium
| | | | - Joris De Ranter
- Department of Plastic and Reconstructive Surgery, Universitair Ziekenhuis Leuven Campus Gasthuisberg, Leuven, Belgium
| | - Francis Vanneste
- Department of Medical Imaging, AZ Zeno Hospital, Knokke, Belgium
| | - Benoit Hendrickx
- Department of Plastic and Reconstructive Surgery, University Hospital Brussel, Brussel, Belgium
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11
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Mespreuve M, Waked K, Hendrickx B. Visualization techniques of the facial arteries. J Cosmet Dermatol 2021; 20:386-390. [PMID: 32459040 PMCID: PMC7891589 DOI: 10.1111/jocd.13477] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND As the face is known for its extreme variation in vascular anatomy and the number of filler-associated complications due to intra-arterial injection is increasing, we are in need of a method to visualize anyone's individual arterial anatomy of the face in a completely harmless way. AIMS The different medical imaging methods and a recently developed MRA protocol are reviewed. METHODS The literature of the last twenty years-with special attention for the last five years-concerning the different medical imaging modalities of the facial arteries was reviewed. RESULTS A harmless visualisation of the facial arteries is currently only possible with US or MRA. US may identify single vessels but never the complete arterial network. A combination of IR "heat enhancement" and a MRA 3D-TOF sequence might make it feasible to visualize a large number of facial arteries in a risk-free, radiation-free, contrast-free and non-invasive way. CONCLUSION Currently, a new combination of IR "heat enhancement" and a MRA 3D-TOF sequence might be the only method to visualize a large number of facial arteries.
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Affiliation(s)
- Marc Mespreuve
- Department of Medical ImagingUniversity Hospital GhentGhentBelgium
- Department of Medical ImagingA.Z. St. MaartenMechelenBelgium
| | - Karl Waked
- Department of Plastic and Reconstructive SurgeryUniversity Hospital BrusselBrusselBelgium
| | - Benoit Hendrickx
- Department of Plastic and Reconstructive SurgeryUniversity Hospital BrusselBrusselBelgium
- Department of Plastic and Reconstructive SurgeryAZ ZenoKnokke‐HeistBelgium
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12
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Liao Z, Zou L, Peng W, Ming B, Zhang Y, Liu G, Ma C. Improving the accuracy of pre-operative evaluation of neurovascular conflict in trigeminal neuralgia using magnetic resonance subtraction. Neuroradiology 2021; 63:295-303. [PMID: 33392731 DOI: 10.1007/s00234-020-02624-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/14/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the ability of magnetic resonance (MR) subtraction to evaluate neurovascular conflict (NVC) and to compare it with conventional MR protocols. METHODS This prospective study included 82 patients with trigeminal neuralgia who underwent microvascular decompression for NVC. All patients had a pre-operative examination using 3T MRI. The MRI protocols used comprised 3D balanced (B)-fast field echo (FFE), 3D steady-state magnetic resonance angiography (MRA), and 3D T1-FFE sequences. MR subtraction images were obtained by subtracting native images from B-FFE and steady-state MRA. NVC evaluation was performed using subtraction images (MR subtraction) and combination images (conventional MR protocols using B-FFE and T1-FFE in combination). Clinical assessment of the degree of compression, the type of compressing vessel, and the location of conflict were undertaken by two independent observers. The two methods were then compared using surgical criteria. RESULTS MR subtraction exhibited greater accuracy than the conventional method in terms of the estimated severity of conflict (87.80% vs. 57.32%, p < 0.05), and demonstrated better consistency with surgical findings (k = 0.794 vs. k = 0.365, p < 0.05). For the type of compressing vessel and the location of conflict, both methods were highly accurate and agreed to a similar extent with surgical findings (p = 0.987, compressing vessel; p = 0.665, location of conflict). CONCLUSION MR subtraction proved reliable in NVC pre-operative evaluation, with increased accuracy when estimating severity. This result strongly supports the wider use of MR subtraction as the preferred choice in clinical application.
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Affiliation(s)
- Zhenhong Liao
- Department of Radiology, People's Hospital of Deyang City, 173 Taishan North Road, Jingyang District, Deyang City, Sichuan Province, China
| | - Linbo Zou
- Department of Neurosurgery, People's Hospital of Deyang City, 173 Taishan North Road, Jingyang District, Deyang City, Sichuan Province, China
| | - Wei Peng
- Department of Radiology, People's Hospital of Deyang City, 173 Taishan North Road, Jingyang District, Deyang City, Sichuan Province, China
| | - Bing Ming
- Department of Radiology, People's Hospital of Deyang City, 173 Taishan North Road, Jingyang District, Deyang City, Sichuan Province, China
| | - Yong Zhang
- Department of Radiology, People's Hospital of Deyang City, 173 Taishan North Road, Jingyang District, Deyang City, Sichuan Province, China
| | - Gaoyuan Liu
- Department of Radiology, People's Hospital of Deyang City, 173 Taishan North Road, Jingyang District, Deyang City, Sichuan Province, China
| | - Chun Ma
- Department of Radiology, People's Hospital of Deyang City, 173 Taishan North Road, Jingyang District, Deyang City, Sichuan Province, China.
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Ding S, Yan X, Guo H, Yin F, Sun X, Yang A, Yao W, Zhang J. Morphological characteristics of the vertebrobasilar artery system in patients with hemifacial spasm and measurement of bending length for evaluation of tortuosity. Clin Neurol Neurosurg 2020; 198:106144. [PMID: 32932027 DOI: 10.1016/j.clineuro.2020.106144] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/05/2020] [Accepted: 08/07/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Dominant vertebral artery (DVA), tortuosity, and elongation of the vertebrobasilar artery system are frequently observed in hemifacial spasm (HFS). However, the morphological characteristics of the tortuosity of vertebrobasilar artery system have not yet been elucidated. In this study, we presented a novel method for the measurement of the bending length (BL) of the basilar artery(BA) or vertebral artery (VA) to assess the tortuosity of vertebrobasilar artery system in HFS patients. METHODS The demographic and morphological characteristics of 135 patients with HFS admitted to the neurosurgical department to undergo microvascular decompression (MVD) were analyzed in this retrospective study. The BL was defined to appraise the tortuous degree of the vertebrobasilar artery system, and according to the BL value, the patients with HFS were divided into two groups: tortuous vertebrobasilar artery (TVA) and non-TVA groups. Additionally, the vessels responsible for HFS were analyzed based on the results of magnetic resonance imaging (MRI) of the two groups. The patients were followed up for 2-6 years post-discharge, and the effect of MVD operation was compared between the two groups. RESULTS DVA was detected in 60.2% of HFS patients; the incidence of left-sided HFS in the TVA group was significantly higher than that in the non-TVA group (P = 0.013). The proportion of multiple responsible vessels in the TVA group was 68.4% (54/79), while that in the non-TVA group was 4.1% (2/49). The complication rate of the two groups was different, and that of the tortuous group was higher than that of the non-tortuous group. CONCLUSIONS The morphological characteristics of the vertebrobasilar artery system in patients with HFS were complex. The measurement of BL is an easy and reliable tool to assess the tortuosity of the vertebrobasilar artery system in HFS patients.
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Affiliation(s)
- Shengchao Ding
- Beijing Tiantan Hospital, Capital Medical University, Nan Si Huan Xi Lu 119, Fengtai District, Beijing 100070, China; Department of Neurosurgery, Aerospace Center Hospital, Yuquan Road 15, Haidian District, Beijing, 100049, China
| | - Xin Yan
- Department of Neurosurgery, Aerospace Center Hospital, Yuquan Road 15, Haidian District, Beijing, 100049, China
| | - Hui Guo
- Department of Neurosurgery, Aerospace Center Hospital, Yuquan Road 15, Haidian District, Beijing, 100049, China
| | - Feng Yin
- Department of Neurosurgery, Aerospace Center Hospital, Yuquan Road 15, Haidian District, Beijing, 100049, China
| | - Xiaodong Sun
- Department of Neurosurgery, Aerospace Center Hospital, Yuquan Road 15, Haidian District, Beijing, 100049, China
| | - Anchao Yang
- Beijing Tiantan Hospital, Capital Medical University, Nan Si Huan Xi Lu 119, Fengtai District, Beijing 100070, China
| | - Wei Yao
- TaoYuan East Street, Shunping County, Baoing City, Hebei Province, China
| | - Jianguo Zhang
- Beijing Tiantan Hospital, Capital Medical University, Nan Si Huan Xi Lu 119, Fengtai District, Beijing 100070, China.
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Holste K, Sahyouni R, Teton Z, Chan AY, Englot DJ, Rolston JD. Spasm Freedom Following Microvascular Decompression for Hemifacial Spasm: Systematic Review and Meta-Analysis. World Neurosurg 2020; 139:e383-e390. [PMID: 32305605 PMCID: PMC7899163 DOI: 10.1016/j.wneu.2020.04.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/01/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Hemifacial spasm (HFS) is a debilitating disorder characterized by intermittent involuntary movement of muscles innervated by the facial nerve. HFS is caused by neurovascular compression along the facial nerve root exit zone and can be treated by microvascular decompression (MVD). The goal was to determine rates and predictors of spasm freedom after MVD for HFS. METHODS A literature search using the key terms "microvascular decompression" and "hemifacial spasm" was performed. The primary outcome variable was spasm freedom at last follow-up. Analysis was completed to evaluate for variables associated with spasm-free outcome. RESULTS A total of 39 studies including 6249 patients were analyzed. Overall spasm freedom rate was 90.5% (5652/6249) at a follow-up of 1.25 ± 0.04 years. There was no significant relationship between spasm freedom versus persistent spasm and age at surgery, timing of follow-up, gender, disease duration, side of disease, or vessel type. Spasm freedom was more likely after an initial surgery versus a redo MVD (odds ratio 4.16, 95% confidence interval 1.99-8.68; P < 0.01). CONCLUSIONS MVD works well for HFS with cure rates >90% at 1-year follow-up in 6249 patients from 39 studies. A significant predictor of long-term spasm freedom at 1 year was an initial MVD as compared to repeat MVD. The majority of published manuscripts on MVD for HFS are heterogeneous single-institutional retrospective studies. As such, a large-scale meta-analysis reporting outcome rates and evaluating significant predictors of spasm freedom provides utility in the absence of randomized controlled studies.
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Affiliation(s)
- Katherine Holste
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
| | - Ronald Sahyouni
- Department of Neurological Surgery, University of California, Irvine, California, USA
| | - Zoe Teton
- Department of Neurosurgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Alvin Y Chan
- Department of Neurological Surgery, University of California, Irvine, California, USA
| | - Dario J Englot
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John D Rolston
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
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Hendrickx B, Waked K, Mespreuve M. Infrared Thermally Enhanced 3-Dimensional Time of Flight Magnetic Resonance Angiography Imaging for the Visualization of the Arteries of the Face. Aesthet Surg J Open Forum 2020; 2:ojaa020. [PMID: 33791645 PMCID: PMC7671261 DOI: 10.1093/asjof/ojaa020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background The face is known for its extreme variation in vascular anatomy. Furthermore, the rapidly increasing number of filler treatments leads to an increase in severe filler-associated complications (such as skin necrosis and blindness) due to intra-arterial injection. Visualizing a patient’s individual complete facial arterial anatomy in a contrast- and radiation-free way has not been published before. This innovative imaging technique could, therefore, enhance the safety of minimally invasive surgical procedures as it provides a harmless way to map the arteries of the face. Objectives Evaluate a newly developed imaging technique to visualize the arteries of the face in a noninvasive and radiation-free manner. Methods The individual arterial facial anatomy of 20 volunteers was studied by an imaging technique, combining infrared (IR) facial warming and 3-dimensional (3D) time of flight (TOF) magnetic resonance angiography (MRA). The source and maximum intensity projection images were assessed by 2 investigators, familiar with the anatomy of the face. Results The MRA technique visualized most of the main facial arteries, albeit in a variable way. The main facial branches of the external carotid artery (facial, angular, supralabial, and superficial temporal arteries) were illustrated well, whereas the visualization of the internal carotid branches (supratrochlear and supraorbital arteries) and nasal branches (dorsal nasal and lateral nasal arteries) was less consistent. Conclusions The combination of IR “heat-induced enhancement” and a 3D-TOF MRA sequence may actually be an important step toward the visualization of the variable facial vascular anatomy in a noninvasive, radiation-free, and contrast-free manner.
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Affiliation(s)
- Benoit Hendrickx
- Department of Plastic and Reconstructive Surgery, AZ Zeno, Knokke-Heist, Belgium
| | - Karl Waked
- Department of Plastic and Reconstructive Surgery, UZ Brussel, Jette, Belgium
| | - Marc Mespreuve
- Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium
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Role of Fused Three-Dimensional Time-of-Flight Magnetic Resonance Angiography and 3-Dimensional T2-Weighted Imaging Sequences in Neurovascular Compression. World Neurosurg 2020; 133:e180-e186. [DOI: 10.1016/j.wneu.2019.08.190] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 08/23/2019] [Accepted: 08/24/2019] [Indexed: 12/31/2022]
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Liu D, Shi P, Li K, Guo Y, Liu X, Wang C, Liu Y, He B, Zhang X. Preoperative visualization of neurovascular contact with 3D-FIESTA combined with 3D-TOF MRA to guide microvascular decompression surgery planning. JOURNAL OF NEURORESTORATOLOGY 2020. [DOI: 10.26599/jnr.2020.9040005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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.
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18
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Dumot C, Sindou M. Veins of the Cerebellopontine Angle and Specific Complications of Sacrifice, with Special Emphasis on Microvascular Decompression Surgery. A Review. World Neurosurg 2018; 117:422-432. [PMID: 29966798 DOI: 10.1016/j.wneu.2018.06.160] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 02/07/2023]
Abstract
Good knowledge of the anatomy of veins is of crucial importance for the functional surgery of cranial nerve (CN) disorders, especially microvascular decompression for trigeminal neuralgia (TN), hemifacial spasm (HFS), and vagoglossopharyngeal neuralgia (VGPN). Although controversial, veins may be involved in neurovascular conflicts and may constitute dangerous obstacles to access to the CNs. With the aim of estimating the implications of veins in those diseases and evaluating the linked surgical difficulties, we carried out a review of the literature from 2000 to the end of February 2018. For this review, articles found on PubMed that gave enough precision about veins were retained (39 articles on TN, 38 on HFS, 8 on VGPN, and 26 on complications related to venous sacrifices). Before this review, we described a simplified anatomic classification of veins, amenable to easing the surgical approach to CNs. Access to the trigeminal nerve, via the infratentorial-supracerebellar route, is almost always affected by the superficial superior petrosal venous system, whereas access to the facial and cochleovestibular complex as well as to the lower CNs, through the infrafloccular trajectory, is almost always exempt of important venous obstacles. Respective incidences of venous compression at the origin of hyperactive CN syndromes are given. The percentages of a venous conflict alone were calculated at 10.8% for TN, 0.1% for HFS, and 2.9% for VGPN. We review the complications considered in relation with venous sacrifices. Precautions to minimize these complications are given.
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Affiliation(s)
- Chloé Dumot
- Hôpital neurologique Pierre Wertheimer, Lyon, France; Université Lyon 1, Lyon, France.
| | - Marc Sindou
- Université Lyon 1, Lyon, France; Groupe ELSAN, Clinique Bretéché, Nantes, France
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19
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Hermier M. Imaging of hemifacial spasm. Neurochirurgie 2018; 64:117-123. [DOI: 10.1016/j.neuchi.2018.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 01/15/2018] [Accepted: 01/27/2018] [Indexed: 10/17/2022]
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Abstract
OPINION STATEMENT The treatment of both hemifacial spasm (HFS) and blepharospasm (BEB) requires making the appropriate clinical diagnosis. Advance imaging and electrophysiologic studies are useful; however, one's clinical suspicion is paramount. The purpose of this review is to summarize current and emerging therapies for both entities. Botulinum toxin (BTX) remains the first-line therapy to treat both conditions. If chemodenervation has failed, surgery may be considered. Due to the risks associated with surgery, the benefits of this option must be carefully weighed. Better surgical outcomes are possible when procedures are performed at tertiary centers with experienced surgeons and advanced imaging techniques. Microvascular decompression is an efficacious method to treat HFS, and myectomy is an option for medication-refractory BEB; the risks of the latter may outweigh any meaningful clinical benefits. Oral agents only provide short-term relief and can cause several unwanted effects; they are reserved for patients who cannot receive BTX and/or surgery. Transcranial magnetic stimulation has gained some traction in the treatment of BEB and may provide safer non-invasive options for refractory patients in the future.
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Affiliation(s)
- Kemar E Green
- Departments of Neurology and Ophthalmology, Michigan State University, East Lansing, MI, USA.
| | - David Rastall
- Michigan State University, College of Osteopathic Medicine, East Lansing, MI, USA
| | - Eric Eggenberger
- Departments of Ophthalmology and Neurology, Mayo Clinic Florida, Jacksonville, FL, USA
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Deep NL, Fletcher GP, Nelson KD, Patel AC, Barrs DM, Bendok BR, Hoxworth JM. Magnetic Resonance Imaging Assessment of Vascular Contact of the Facial Nerve in the Asymptomatic Patient. J Neurol Surg B Skull Base 2016; 77:503-509. [PMID: 27857878 DOI: 10.1055/s-0036-1584196] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 04/17/2016] [Indexed: 10/21/2022] Open
Abstract
Objective The objective of this study was to determine the prevalence of facial nerve vascular contact on magnetic resonance imaging (MRI) in patients without hemifacial spasm (HFS). Study Design Our radiology database was queried to identify consecutive adult patients without a history of HFS, intracranial tumor, brain radiation therapy, intracranial surgery, traumatic brain injury, or trigeminal nerve vascular compression. One hundred high-resolution MRIs of the posterior fossa were independently reviewed by two neuroradiologists for facial nerve vascular contact (200 sides). Main Outcome Measures The prevalence of vascular nerve contact in the non-HFS patient, the location of contact along the facial nerve, the culprit vessel, and severity of compression was recorded. Results The presence of vascular contact in the non-HFS patient may be as high as 53%. It is typically mild to moderate in severity, most commonly involves the cisternal portion, and usually caused by the anterior inferior cerebellar artery. Conclusion Vascular contact of the facial nerve is frequently identified in asymptomatic individuals but tends to be more peripheral and mild compared with previous descriptions of neurovascular contact in HFS patients. These results should be considered in assessing the candidacy of HFS patients for microvascular decompression.
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Affiliation(s)
- Nicholas L Deep
- Department of Otorhinolaryngology, Mayo Clinic, Phoenix, Arizona, United States
| | - Geoffrey P Fletcher
- Neuroradiology Division, Department of Radiology, Mayo Clinic, Phoenix, Arizona, United States
| | - Kent D Nelson
- Neuroradiology Division, Department of Radiology, Mayo Clinic, Phoenix, Arizona, United States
| | - Ameet C Patel
- Neuroradiology Division, Department of Radiology, Mayo Clinic, Phoenix, Arizona, United States
| | - David M Barrs
- Department of Otorhinolaryngology, Mayo Clinic, Phoenix, Arizona, United States
| | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, United States
| | - Joseph M Hoxworth
- Neuroradiology Division, Department of Radiology, Mayo Clinic, Phoenix, Arizona, United States
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