Application of 3D image reconstruction using 3D Slicer software in microvascular decompression for patients with primary trigeminal neuralgia

SHAN Ming; WANG Yi; LÜ Bo; MAO Hong-liang; CHENG Hong-wei

doi:10.13798/j.issn.1009-153X.2024.02.001

Abstract：Objective To investigate the application value of three-dimensional(3D)image reconstruction in microvascular decompression(MVD)for primary trigeminal neuralgia(PTN).Methods A retrospective analysis was conducted on the clinical data of 56 patients with PTN who underwent MVD from January 2020 to December 2022.Pre-operatively,3D-TOF-MRA and 3D-FIESTA scans were performed,and the 3D Slicer software was used for 3D image reconstruction to understand the relationship between vessels and nerves,identify the running course of responsible vessels,and simulate the surgery.An endoscope was used during surgery when the responsible vessels were not fully exposed under a microscope.Results The responsible vessele were confirmed during surgery in 55 patients,of whom 12 were confirmed by endoscope,and no responsible vessels were found in one case during surgery.The responsible vessels identified by the preoperative 3D reconstruction images was consistent with those found during surgery in 53 patients.The preoperative 3D reconstruction images were negative in 3 patients,including 2 patients confirmed as vein compression during surgery and 1 without finding the responsible vessel.The pain disappeared immediately in 42 patients after surgery,significantly improved in 13,and did not change in 1.Postoperative facial numbness occurred in 4 patients and herpes zoster in 1,which were improved after symptomatic treatment.The follow-up ranged from 15 months to 47 months.The BNI grade Ⅰ～Ⅱ was achieved in 53 patients,grade Ⅲ in 2,and grade Ⅳ in 1.The effective rate was 94.6％.Conclusions For patients with PTN undergoing MVD,3D image reconstruction using 3D Slicer software can assist in pre-operative clarification of the responsible vessels and their running course,which can simulate surgery to optimize surgical planning and reduce unnecessary exploration and traction during surgery.The endoscope can complement the blind area of the microscope and help expose the responsible vessels,reducing the risk of missing responsible vessels,and can also assist in confirming and adjusting the position of Teflon pads in order to improve the surgical outcomes.