gms | German Medical Science

Objective: The implementation, technical aspects and clinical use of interactive intraoperative 3D-visualization (IOP-3D) as a setup in microvascular decompression (MVD) of hyperactive cranial nerve syndromes was investigated. Till now IOP-3D has not been introduced to microneurosurgical procedures.

Methods: 50 patients with neurovascular compression syndromes - trigeminal neuralgia (TN), hemifacial spasm (HFS) and glossopharyngeal neuralgia (GN) were evaluated. All underwent MVD. MRI was performed with the CISS-sequence (constructive interference in steady state). Image processing consisted of semiautomatic explicit and implicit segmentation, direct volume rendering and if necessary image fusion. 3D visualization was directly introduced to the operative area on a mobile computer system and manipulated by plasma sterilized remote control devices such as wireless mouse and keyboard.

Results: The technical system was stable during all procedures without any malfunction of hard- and software components. It was possible to observe and clarify the individual neurovascular relationships by interactively adjusting the 3D visualization according to the microscopic or views not represented by this referring to virtual endoscopy. Neurovascular conflicts were explored in all patients during MVD. IOP-3D delineated the impinging vessels and respective cranial nerves in 49 of 50 patients (98%). Postoperatively, all patients with TN and GN showed pain relief and in cases of HFS, a resolution of facial twitching was achieved. It did not prolong MVD (minimum 2, maximum 5, mean 3,5 hours) and contributed to reducing the time in difficult cases. No bacterial infections occurred.

Conclusions: IOP-3D offers non-invasive virtual exploration of the global individual neurovascular relationships during MVD. It proved to be advantageous for optimizing microneurosurgical procedures, the operative results, teaching and supporting superior safety when compared to the conventional strategy.