To Utilization Of 3D Slicer Modeling And Lateral Spread Response Monitoring In Microvascular Decompression Of Hemifacial Spasm

Objective Detection of lateral spread response(LSR)to monitor the judgment and prognosis of responsible vessels during microvascular decompression(MVD)in patients with hemifacial spasm(HFS).At the same time,we also aim to evaluate the benefits of using 3D-Slicer modeling to achieve three-dimensional reconstruction so as to better describe the neurovascular relationship(NVR)and compression in root exit zone.Method The 40 patients with HFS treated with MVD under electrophysiological monitoring in our hospital from April 2015 to June 2021 were analyzed.All patients were scanned with 3D-CISS and 3D-TOF MRA sequence before operation,and monitored by LSR during operation.Three-dimensional reconstruction was performed with 3D-Slicer technique to evaluate the relationship between nerve and blood vessels,and compared with 3D-CISS and 3D-TOF MRA sequence and intraoperative findings.Result All the patients in this group were followed up 12 months after LSR.Among the 4 cases whose LSR decreased by less than 50%,2 case was cured,1 case was improved and 1 case was ineffective.Of the 3 cases whose LSR did not disappear after operation,1 case was cured and 2 case was ineffective.Among the 33 patients with satisfactory LSR and intraoperative electrophysiological remission(disappearance of LSR),31 cases were cured,1 case improved and 1 case was ineffective.The total remission rate of LSR disappearance group was 96.7%(32/33),LSR dissatisfaction group(the decrease of LSR was lower than that of 50%+LSR persistence)was57.1%(4/7,P<0.05)At the same time,in terms of predicting NVR,the K value between3D-CISS and 3D-TOF MRA sequences and intraoperative findings was 0.389,(the consistency is close to average).and that between 3D modeling and intraoperative findings was 0.691,(the consistency is close to good).In terms of identifying responsible vessels,the K values of 3D-CISS and 3D-TOF MRA sequences and intraoperative findings were 0.492(the consistency is average),and those of 3D modeling and intraoperative findings were 0.778(the consistency is good).Conclusion MVD combined with LSR monitoring plays an important role in accurately identifying responsible vessels and evaluating prognosis during HFS.At the same time,3D modeling has better consistency than traditional preoperative imaging and intraoperative comparison in judging neurovascular relationship and identifying responsible vessels,and 3D modeling can describe this area more clearly than traditional preoperative imaging.The use of 3D modeling in the preoperative environment may help to accurately locate and guide surgical planning,thus improving the prognosis of patients with HFS.Both of them are of great significance for the development of precision neurosurgery.