title: 3D Computer graphics simulation to obtain optimal surgical exposure during microvascular decompression of the glossopharyngeal nerve.
abstract: The affected artery in glossopharyngeal neuralgia (GPN) is most often the posterior inferior cerebellar artery (PICA) from the caudal side or the anterior inferior cerebellar artery (AICA) from the rostral side. This technical report describes two representative cases of GPN, one with PICA as the affected artery and the other with AICA, and demonstrates the optimal approach for each affected artery. We used 3D computer graphics (3D CG) simulation to consider the ideal transposition of the affected artery in any position and approach. Subsequently, we performed microvascular decompression (MVD) surgery based on this simulation. For PICA, we used the transcondylar fossa approach in the lateral recumbent position, very close to the prone position, with the patient's head tilted anteriorly for caudal transposition of PICA. In contrast, for AICA, we adopted a lateral suboccipital approach with opening of the lateral cerebellomedullary fissure, to visualize better the root entry zone of the glossopharyngeal nerve and to obtain a wide working space in the cerebellomedullary cistern, for rostral transposition of AICA. Both procedures were performed successfully. The best surgical approach for MVD in patients with GPN is contingent on the affected artery--PICA or AICA. 3D CG simulation provides tailored approach for MVD of the glossopharyngeal nerve, thereby ensuring optimal surgical exposure.
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Hiraishi
authors.forename: Toshio
authors.initials: T
authors.lastname: Matsushima
authors.forename: Masatou
authors.initials: M
authors.lastname: Kawashima
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Nakahara
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ito
authors.forename: Makoto
authors.initials: M
authors.lastname: Oishi
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Fujii
mesh_terms: D000368:Aged; D002531:Cerebellum / Q000098:blood supply / Q000601:surgery; D002536:Cerebral Arteries / Q000601:surgery; D002560:Cerebrovascular Circulation; D003196:Computer Graphics; D003198:Computer Simulation; D035262:Cranial Fossa, Anterior / Q000601:surgery; D003627:Data Interpretation, Statistical; D005260:Female; D005930:Glossopharyngeal Nerve / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D061145:Microvascular Decompression Surgery / Q000379:methods*; D008875:Middle Aged; D010608:Pharyngeal Diseases / Q000601:surgery; D013035:Spasm / Q000601:surgery