BMC neurology · 2026
Preoperative 3D slicer reconstruction and the prognostic value of dynamic intraoperative lateral spread response assessment in vertebrobasilar dolichoectasia-associated hemifacial spasm.
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Li Yang, Shi Hailiang, Wang Yinzhan, Qian Tao, Wen Xiaolong, Zhang Zhenghao, Du Yihui, Shi Haowei, Yang Zijiang, Cui Jianzhong
Аннотация
OBJECTIVE: To evaluate the value of 3D Slicer-based reconstruction for preoperative identification of offending vessels in patients with vertebrobasilar dolichoectasia (VBD)-associated hemifacial spasm (HFS) undergoing microvascular decompression (MVD), and to investigate the prognostic value of dynamic intraoperative lateral spread response (LSR) assessment.
METHODS: This retrospective study included 176 patients with HFS who underwent MVD between June 2021 and February 2023; among them, 84 patients had VBD. All patients underwent preoperative 3D time-of-flight magnetic resonance angiography and 3D fast imaging employing steady-state acquisition magnetic resonance imaging, followed by 3D Slicer-based reconstruction. Intraoperative findings were used as the reference standard to compare conventional image assessment with 3D Slicer-based reconstruction for offending-vessel identification in patients with VBD. Postoperative outcomes, complications, and the associations of conventional LSR findings, dynamic intraoperative LSR findings, and immediate postoperative symptom relief with 1-year outcome were also analyzed.
RESULTS: In patients with VBD, the concordance rate with intraoperative findings for identification of a single offending vessel was significantly higher with 3D Slicer-based reconstruction than with conventional image assessment (88.37% vs. 60.47%, P = 0.006). For multiple offending vessels, the concordance rates were 81.08% and 62.16%, respectively (P = 0.121). Overall concordance rates were 82.14% and 58.33%, respectively (P = 0.001). The difficulty score for neurovascular relationship assessment was lower with 3D Slicer-based reconstruction than with conventional image assessment (0.369 ± 0.757 vs. 1.13 ± 0.915, P < 0.001). At 1 year, 78 of 84 patients in the VBD group achieved complete symptom resolution. Symptom relief did not differ significantly between the VBD and non-VBD groups at any follow-up time point (all P > 0.05). Postoperative hearing loss was more frequent in the VBD group (22.62% vs. 11.24%, P = 0.036), whereas facial palsy rates were comparable (P = 0.494). Within the VBD group, dynamic intraoperative LSR findings and immediate postoperative symptom relief were significantly associated with 1-year outcome (both P < 0.001), whereas conventional LSR findings were not (P = 0.683).
CONCLUSIONS: In VBD-associated HFS, 3D Slicer-based reconstruction improved offending-vessel identification and reduced the difficulty of preoperative neurovascular assessment. Dynamic intraoperative LSR findings, rather than conventional LSR findings, were associated with 1-year outcome and may represent a potentially useful prognostic indicator.
METHODS: This retrospective study included 176 patients with HFS who underwent MVD between June 2021 and February 2023; among them, 84 patients had VBD. All patients underwent preoperative 3D time-of-flight magnetic resonance angiography and 3D fast imaging employing steady-state acquisition magnetic resonance imaging, followed by 3D Slicer-based reconstruction. Intraoperative findings were used as the reference standard to compare conventional image assessment with 3D Slicer-based reconstruction for offending-vessel identification in patients with VBD. Postoperative outcomes, complications, and the associations of conventional LSR findings, dynamic intraoperative LSR findings, and immediate postoperative symptom relief with 1-year outcome were also analyzed.
RESULTS: In patients with VBD, the concordance rate with intraoperative findings for identification of a single offending vessel was significantly higher with 3D Slicer-based reconstruction than with conventional image assessment (88.37% vs. 60.47%, P = 0.006). For multiple offending vessels, the concordance rates were 81.08% and 62.16%, respectively (P = 0.121). Overall concordance rates were 82.14% and 58.33%, respectively (P = 0.001). The difficulty score for neurovascular relationship assessment was lower with 3D Slicer-based reconstruction than with conventional image assessment (0.369 ± 0.757 vs. 1.13 ± 0.915, P < 0.001). At 1 year, 78 of 84 patients in the VBD group achieved complete symptom resolution. Symptom relief did not differ significantly between the VBD and non-VBD groups at any follow-up time point (all P > 0.05). Postoperative hearing loss was more frequent in the VBD group (22.62% vs. 11.24%, P = 0.036), whereas facial palsy rates were comparable (P = 0.494). Within the VBD group, dynamic intraoperative LSR findings and immediate postoperative symptom relief were significantly associated with 1-year outcome (both P < 0.001), whereas conventional LSR findings were not (P = 0.683).
CONCLUSIONS: In VBD-associated HFS, 3D Slicer-based reconstruction improved offending-vessel identification and reduced the difficulty of preoperative neurovascular assessment. Dynamic intraoperative LSR findings, rather than conventional LSR findings, were associated with 1-year outcome and may represent a potentially useful prognostic indicator.