Preoperative evaluation of neurovascular relationships for microvascular decompression in the cerebellopontine angle in a virtual reality environment.
OBJECTIVE
In this paper the authors' goal was to evaluate the feasibility and efficacy of a virtual reality (VR) system in preoperative planning for microvascular decompression (MVD) procedures treating idiopathic trigeminal neuralgia and hemifacial spasm. The system's role in surgical simulation and training was also assessed.


METHODS
Between May 2008 and April 2009, the authors used the Dextroscope system to visualize the neurovascular complex and simulate MVD in the cerebellopontine angle in a VR environment in 16 patients (6 patients had trigeminal neuralgia and 10 had hemifacial spasm). Reconstructions were carried out 2-3 days before MVD. Images were printed in a red-blue stereoscopic format for teaching and discussion and were brought into the operating room to be compared with real-time intraoperative findings.


RESULTS
The VR environment was a powerful aid for spatial understanding of the neurovascular relationship in MVD for operating surgeons and trainees. Through an initial series of comparison/confirmation experiences, the senior neurosurgeon became accustomed to the system. He could predict intraoperative problems and simulate surgical maneuvering, which increased his confidence in performing the procedure.


CONCLUSIONS
The Dextroscope system is an easy and rapid method to create a stereoscopic neurovascular model for MVD that is highly concordant with intraoperative findings. It effectively shortens the learning curve and adds to the surgeon's confidence.
Department of Neurosurgery, Huashan Hospital of Fudan University, Shanghai, China.
Zhuo-Ying
ZY
Du
Xiang
X
Gao
Xiao-Luo
XL
Zhang
Zhi-Qiu
ZQ
Wang
Wei-Jun
WJ
Tang
D000328:Adult; D000368:Aged; D002530:Cerebellopontine Angle / Q000098:blood supply / Q000473:pathology* / Q000601:surgery; D003198:Computer Simulation; D019299:Decompression, Surgical / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D055806:Microvessels / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D008959:Models, Neurological; D019635:Neurosurgical Procedures / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013997:Time Factors; D014584:User-Computer Interface