gms | German Medical Science

64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

Evaluation of clinical outcome of microvascular decompression for hemifacial spasm using advanced processing of high resolution MRI data

Meeting Abstract

  • Barbara Bischoff - Neurochirurgische Klinik, Universitätsklinikum Erlangen, Erlangen
  • Oliver Ganslandt - Neurochirurgische Klinik, Universitätsklinikum Erlangen, Erlangen
  • Ramin Naraghi - Neurochirurgische Abteilung, Bundeswehrkrankenhaus Ulm, Ulm
  • Arnd Doerfler - Neuroradiologische Abteilung, Universitätsklinikum Erlangen, Erlangen
  • Michael Buchfelder - Neurochirurgische Klinik, Universitätsklinikum Erlangen, Erlangen
  • Peter Hastreiter - Neurochirurgische Klinik, Universitätsklinikum Erlangen, Erlangen

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocMO.14.01

doi: 10.3205/13dgnc117, urn:nbn:de:0183-13dgnc1170

Published: May 21, 2013

© 2013 Bischoff et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: The detailed understanding of the complex anatomical relationships between nerves and vessels at the surface of the brainstem is of major importance for the surgical treatment of neurovascular compression (NVC) syndromes using microvascular decompression (MVD). Due to the more ventral access to the site of NVC in case of hemifacial spasm advanced image based planning is crucial for optimal surgery and the related clinical outcome. In this regard, high resolution MRI of the brainstem is an established technique. In order to overcome the limitations of pure 2D slice representations regarded as insufficient for the complex anatomy, multi-data fusion and 3D visualization has been applied.

Method: A consecutive series of 69 patients suffering form hemifacial spasm were treated with MVD from 1991 to 2012. Considering the period from 1991 to 2002, n = 18 patients (group_1) were prepared for surgery using 2D slice images only (T2 weighted MRI). In contrast to that in the period from 2002 to 2012, n = 50 patients (group_2) obtained advanced preoperative planning with one patient lost to follow-up. Aiming at improved representation of the vascular situation in the vicinity of the facial nerve, strongly T2 weighted MR data using the CISS (constructive interference in steady state) protocol and angiographic MR data using the TOF (time of flight) protocol were fused. The resulting optimized image data were presented with techniques of 3D visualization in preparation of and during surgery. For both patient groups the immediate postoperative and the long-term clinical outcome were retrospectively analyzed.

Results: Concerning group_1 prepared for surgery with 2D image data only 10 out of 18 patients (rate = 56%) had an immediate postoperative relief of hemifacial spasm. On the long-term 13 out of 18 patients (rate = 72%) had entire relief of spasm. In contrast to that regarding group_2 which obtained preoperative planning using 3D visualization of fused MR data, a total of 45 out of 50 patients (rate = 90%) had an immediate postoperative relief of hemifacial spasm. On the long-term 49 out of 50 patients (rate = 98%) had entire relief of spasm.

Conclusions: Fusion of different MRI data with subsequent 3D visualization is a powerful tool for the planning of MVD in hemifacial spasm. This positive effect is clearly demonstrated in the immediate and long-term clinical outcome which results from reliably and accurately guiding the surgeon to the definite site of pathology.