Application value of magnetic resonance 3D-TOF-MRA and 3D-FIESTA sequences in microvascular decompression for primary glossopharyngeal neuralgia

Yue Yong; Zhang Lei; Song Haiyang; Jin Peng

doi:10.11850/j.issn.1009-122X.2024.08.006

Abstract：Objective To investigate the utility of combining magnetic resonance imaging(MRI)with 3D-TOF-MRA and 3D-FIESTA high-resolution sequences in preoperative assessment for microvascular decompression(MVD)in patients with primary glossopharyngeal neuralgia(pGN).Methods The clinical data of 25 patients with pGN were analyzed retrospectively.Preoperative evaluation included 3.0T MRI 3D-TOF-MRA and 3D-FIESTA sequence scans to assess the relationship between the glossopharyngeal nerve and adjacent vessels,which were categorized as no contact,contact,or compression.Vessels that contacted or compressed the nerve were considered responsible vessels.All the patients were treated with MVD,and the responsible vessels observed during surgery were used as the"gold standard".Results Nerve-vessel contact or compression was observed in all 25 patients during the MVD procedure.MRI imaging analysis results were consistent with intraoperative observations in 23 cases and inconsistent in 2 cases(in one case,the responsible vessel was identified as the vertebral artery preoperatively by MRI,but it was found to be the vertebral artery and posterior inferior cerebellar artery during the operation;in another case,no responsible vessel was detected preoperatively by MRI,but it was found to be a branch of the posterior inferior cerebellar artery during the operation).The combined 3D-TOF-MRA and 3D-FIESTA sequence examinations demonstrated an accuracy rate of 92%(23/25)in identifying offending vessels on the symptomatic side,with good consistency with intraoperative observations(κ=0.855,P<0.05).Conclusions The combination of 3D-TOF-MRA and 3D-FIESTA sequences can clearly demonstrate the relationship between the glossopharyngeal nerve and adjacent vessels in pGN patients.This capability aids in identifying responsible vessels,guiding the MVD procedure,and positions it as a crucial adjunctive assessment for preoperative MVD evaluation.