No abstract

BACKGROUND Neurovascular compression (NVC) is the main cause of primary trigeminal neuralgia (TN) and hemifacial spasm (HFS). Microvascular decompression (MVD) is an effective surgical method for the treatment of TN and HFS caused by NVC. The judgement of NVC is a critical step in the preoperative evaluation of MVD, which is related to the effect of MVD treatment. Magnetic resonance imaging (MRI) technology has been used to detect NVC prior to MVD for several years. Among many MRI sequences, three-dimensional time-of-flight magnetic resonance angiography (3D TOF MRA) is the most widely used. However, 3D TOF MRA has some shortcomings in detecting NVC. Therefore, 3D TOF MRA combined with high resolution T2-weighted imaging (HR T2WI) is considered to be a more effective method to detect NVC. AIM To determine the value of 3D TOF MRA combined with HR T2WI in the judgment of NVC, and thus to assess its value in the preoperative evaluation of MVD. METHODS Related studies published from inception to September 2022 based on PubMed, Embase, Web of Science, and the Cochrane Library were retrieved. Studies that investigated 3D TOF MRA combined with HR T2WI to judge NVC in patients with TN or HFS were included according to the inclusion criteria. Studies without complete data or not relevant to the research topics were excluded. The Quality Assessment of Diagnostic Accuracy Studies checklist was used to assess the quality of included studies. The publication bias of the included literature was examined by Deeks’ test. An exact binomial rendition of the bivariate mixed-effects regression model was used to synthesize data. Data analysis was performed using the MIDAS module of statistical software Stata 16.0. Two independent investigators extracted patient and study characteristics, and discrepancies were resolved by consensus. Individual and pooled sensitivities and specificities were calculated. The I² statistic and Q test were used to test heterogeneity. The study was registered on the website of PROSERO (registration No. CRD42022357158). RESULTS Our search identified 595 articles, of which 12 (including 855 patients) fulfilled the inclusion criteria. Bivariate analysis showed that the pooled sensitivity and specificity of 3D TOF MRA combined with HR T2WI for detecting NVC were 0.96 [95% confidence interval (CI): 0.92-0.98] and 0.92 (95%CI: 0.74-0.98), respectively. The pooled positive likelihood ratio was 12.4 (95%CI: 3.2-47.8), pooled negative likelihood ratio was 0.04 (95%CI: 0.02-0.09), and pooled diagnostic odds ratio was 283 (95%CI: 50-1620). The area under the receiver operating characteristic curve was 0.98 (95%CI: 0.97-0.99). The studies showed no substantial heterogeneity ( I 2 = 0, Q = 0.001 P = 0.50). CONCLUSION Our results suggest t...

Neurovascular compression (NVC) is the main cause of hemifacial spasm (HFS) or trigeminal neuralgia (TN), and frequently occurs at the root entry zone of cranial nerves. Microvascular decompression (MVD) is an effective surgical treatment for TN and HFS caused by NVC. The accurate preoperative diagnosis of NVC is crucial to the evaluation of MVD as an appropriate treatment for TN and HFS. Three-dimensional (3D) time-of-flight magnetic resonance angiography (3D TOF MRA) and high resolution T2-weighted imaging (HR T2WI) are used to detect NVC prior to MVD; however, this combination alone has certain disadvantages. Multimodal image fusion (MIF) may combine two or more images from the same or different modalities, allowing neurosurgeons to use the reconstructed 3D model to observe anatomical details more clearly from different perspectives. The aim of the present meta-analysis was to evaluate the effect of 3D MIF based on 3D TOF MRA combined with HR T2WI in the preoperative diagnosis of NVC, and thus to evaluate its clinical application value in the preoperative evaluation of MVD. Relevant studies available on PubMed, Embase, Web of Science, Scopus, China National Knowledge Infrastructure and the Cochrane Library, and published from the inception of each database to September 2022, were retrieved. Studies using 3D MIF based on 3D TOF MRA combined with HR T2WI to diagnose NVC in patients with TN or HFS were included. The Quality Assessment of Diagnostic Accuracy Studies checklist was used to evaluate the quality of the included studies. The statistical software Stata 16.0 was used to perform the meta-analysis. Data extraction was performed by two independent investigators and discrepancies were resolved by discussion. Pooled sensitivities, specificities, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and the area under the receiver operating characteristic curve (AUROC) were calculated as the main summary effect size. The I² and Q-test were used to assess heterogeneity. The present search identified 702 articles, of which 7 (comprising 390 patients) fulfilled the inclusion criteria. Bivariate analysis indicated that the pooled sensitivity and specificity of 3D MIF based on 3D TOF MRA combined with HR T2WI for detecting NVC were 0.97 (95% CI, 0.95-0.99) and 0.89 (95% CI, 0.77-0.95), respectively. The pooled PLR was 8.8 (95% CI, 4.1-18.6), the pooled NLR was 0.03 (95% CI, 0.02-0.06) and the pooled DOR was 291 (95% CI, 99-853). The AUROC was 0.98 (95% CI, 0.97-0.99). The studies had no substantial heterogeneity (I 2 =0; Q=0.000; P=0.50). The present results suggested that 3D MIF based on 3D TOF MRA combined with HR T2WI had excellent sensitivity and specificity for diagnosing NVC in patients with TN or HFS. Therefore, this method should serve a key role in MVD preoperative evaluation.