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  • Title: Value of 3-dimensional high-resolution magnetic resonance imaging in detecting the offending vessel in hemifacial spasm: comparison with intraoperative high definition endoscopic visualization.
    Author: El Refaee E, Langner S, Baldauf J, Matthes M, Kirsch M, Schroeder HW.
    Journal: Neurosurgery; 2013 Jul; 73(1):58-67; discussion 67. PubMed ID: 23695647.
    Abstract:
    BACKGROUND: High-resolution 3-dimensional (3-D) magnetic resonance imaging (MRI) is widely used to predict the neurovascular anatomy within the cerebellopontine angle. OBJECTIVE: To assess the value of 3-D steady-state free precession imaging (SSFP) and time-of-flight magnetic resonance angiography (TOF MRA) in detecting the offending vessels in hemifacial spasm in comparison to intraoperative endoscopic visualization. METHODS: 42 patients underwent endoscope-assisted microvascular decompression (MVD). All available preoperative 3-D SSFP and TOF MRA images were checked. Intraoperative videos were captured by a high-definition endoscopic camera attached to endoscopes while exploring the area of facial nerve root exit zone (REZ). Evaluation of the 3-D images was performed by 2 independent groups of observers and compared with the operative findings. RESULTS: Three-D MRI had an average positive predictive value (PPV) of 89.1% in differentiating between simple and complex compression. Mean accuracy of the images in detection of the offending vessels was 83.3% and 77% according to the first and second groups of observers, respectively. Averaged inter-observer agreement between the 2 groups of observers was substantial, with an averaged Kappa coefficient (K) of 0.56. In the simple compression group, mean accuracy was 97% and 89.4% according to the first and second groups of observers, respectively. Averaged K for agreement was substantial (K = 0.65). CONCLUSION: According to endoscopic visualization, 3-D SSFP and TOF MRA images are accurate in detecting the offending vessels in simple compression of the facial nerve, and in predicting presence of a complex compression with variable sensitivity in identifying all offending vessels.
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