gms | German Medical Science

71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

Enhanced estimation of the clinical outcome after microvascular decompression by superb reliability of MRI for the distinction of arterial and venous conflicts in trigeminal neuralgia

Verbesserte Abschätzung des klinischen Ergebnisses nach mikrovaskulärer Dekompression durch hochauflösende MRT-Kombinationen für die Unterscheidung zwischen arteriellen und venösen neurovaskulären Konflikten bei der Trigeminusneuralgie

Meeting Abstract

  • presenting/speaker Levent Tanrikulu - Universitätsmedizin Göttingen, Göttingen, Deutschland; Universitätsmedizin Göttingen, Göttingen, Deutschland
  • Sebastian Müller - Universitätsmedizin Göttingen, Göttingen, Deutschland; Universitätsmedizin Göttingen, Göttingen, Deutschland
  • Eya Khadhraoui - Universitätsmedizin Göttingen, Göttingen, Deutschland; Universitätsmedizin Göttingen, Göttingen, Deutschland
  • Marios Psychogios - Universitätsmedizin Göttingen, Göttingen, Deutschland; Universitätsmedizin Göttingen, Göttingen, Deutschland
  • Veit Rohde - Universitätsmedizin Göttingen, Göttingen, Deutschland; Universitätsmedizin Göttingen, Göttingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocV027

doi: 10.3205/20dgnc031, urn:nbn:de:0183-20dgnc0319

Published: June 26, 2020

© 2020 Tanrikulu et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Balanced Steady State Free Precession(b-SSFP) sequences, such as CISS or FIESTA, and the newly developed Fast-Spin-Echo(FSE)-Sequences, for example SPACE and VISTA, enable an optimized visualization of causative neurovascular compression (NVC) in patients with trigeminal neuralgia (TN). Microsurgically-found arterial conflicts are mostly associated with a favorable outcome of MVD compared to venous conflicts. An additional Time-of-Flight (ToF) angiography facilitates the differentiation between causative arteries and veins. The goal of this study is to analyze the reliability and impact of the combination of high-resoluted MRI techniques on the prediction of vessel type and the estimation of clinical postoperative outcome of microvascular decompression (MVD).

Methods: 48 patients (m/f: 32/16) underwent MVD of the trigeminal nerve. We analyzed the visualization of cranial nerves (SPACE/VISTA or CISS/Fiesta-C). An additional time of flight angiography was available in 38 cases. The patients were categorized into four subgroups:

1.
NVC negative,
2.
venous NVC,
3.
arterial NVC,
4.
combined arterial and venous NVC.

The preoperative MRI findings were compared to the intraoperative morphological findings. Outcome was quantified by the Barrow Neurological Institute pain score.

Results: 25 pure arterial NVC, 9 venous NVC and 5 combined NVC were seen by MRI. In 9 cases NVC was absent. The neurovascular findings from the MRI correlated in 91.7% of the patients with the intraoperative findings. The examined cases matched in 80% without MRI-TOF, the consistency was enhanced to 94.7% with MRI-TOF. Cronbach’s Alpha was 0.89 overall, 0.90 with MRI-TOF and 0.77 without.

Conclusion: The visualization of CN V using sequences such as b-SSFP or FSE in combination with 3D-ToF angiography enables an optimized delineation of arterial and venous neurovascular conflicts and may allow a more reliable differentiation between veins and arteries, resulting in a better prediction of clinical outcome compared to T2 imaging data alone.