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首页> 外文期刊>World neurosurgery >Multimodal Image-Based Virtual Reality Presurgical Simulation and Evaluation for Trigeminal Neuralgia and Hemifacial Spasm
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Multimodal Image-Based Virtual Reality Presurgical Simulation and Evaluation for Trigeminal Neuralgia and Hemifacial Spasm

机译：基于多模式的图像的虚拟现实预设仿真与三叉神经痛和半侵蚀的评估

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ObjectiveTo address the feasibility and predictive value of multimodal image-based virtual reality in detecting and assessing features of neurovascular confliction (NVC), particularly regarding the detection of offending vessels, degree of compression exerted on the nerve root, in patients who underwent microvascular decompression for nonlesional trigeminal neuralgia and hemifacial spasm (HFS). MethodsThis prospective study includes 42 consecutive patients who underwent microvascular decompression for classic primary trigeminal neuralgia or HFS. All patients underwent preoperative 1.5-T magnetic resonance imaging (MRI) with T2-weighted three-dimensional (3D) sampling perfection with application-optimized contrasts by using different flip angle evolutions, 3D time-of-flight magnetic resonance angiography, and 3D T1-weighted gadolinium-enhanced sequences in combination, whereas 2 patients underwent extra experimental preoperative 7.0-T MRI scans with the same imaging protocol. Multimodal MRIs were then coregistered with open-source software 3D Slicer, followed by 3D image reconstruction to generate virtual reality (VR) images for detection of possible NVC in the cerebellopontine angle. Evaluations were performed by 2 reviewers and compared with the intraoperative findings. ResultsFor detection of NVC, multimodal image-based VR sensitivity was 97.6% (40/41) and specificity was 100% (1/1). Compared with the intraoperative findings, the κ coefficients for predicting the offending vessel and the degree of compression were >0.75 (P< 0.001). The 7.0-T scans have a clearer view of vessels in the cerebellopontine angle, which may have significant impact on detection of small-caliber offending vessels with relatively slow flow speed in cases of HFS. ConclusionsMultimodal image-based VR using 3D sampling perfection with application-optimized contrasts by using different flip angle evolutions in combination with 3D time-of-flight magnetic resonance angiography sequences proved to be reliable in detecting NVC and in predicting the degree of root compression. The VR image-based simulation correlated well with the real surgical view.
机译：ObjectiveTo解决了基于多模式图像的虚拟现实的可行性和预测值，在检测和评估神经血管冲突（NVC）的特征中，特别是关于骤流血管的检测，在接受微血管减压的患者中施加在神经根上的压缩程度无源性三叉神经痛和半侵蚀（HFS）。方法可以预期研究包括42例随后进行微血管减压的连续患者，用于经典的主要三叉神经痛或HFS。所有患者均接受术前1.5-T磁共振成像（MRI），采用T2加权三维（3D）采样完美，采用不同的翻转角度演进，3D飞行时间磁共振血管造影和3D T1，采用应用优化对比度 - 重量的钆增强序列组合，而2例患者接受过额外的实验术前7.0-T MRI扫描相同的成像协议。然后，多式联运MRIS用开源软件3D切片器进行内心注入，其次是3D图像重建，以产生虚拟现实（VR）图像以检测Cerebellopontine角度的可能NVC。评估由2名审稿人进行，并与术中发现进行比较。结果检测NVC，基于多模式的VR敏感性为97.6％（40/41），特异性为100％（1/1）。与术中发现相比，用于预测骤流血管的κ系数和压缩程度> 0.75（P <0.001）。 7.0-T扫描具有细胞骨折角度的血管视图，这可能对HFS案例中具有相对缓慢的流速的小口径违规血管进行显着影响。结论使用3D采样的基于图像的VR，通过使用不同的翻转角度进化与3D飞行时间的磁共振血管造影序列组合使用不同的翻转角度变化，证明在检测NVC和预测根部压缩程度方面是可靠的。基于VR图像的仿真与真实的外科视图很好。

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