Computational Fluid Dynamics as an Indicator of Offending Vessel in Trigeminal Neuralgia and Hemifacial Spasms

Abstract

Context: Newer Imaging tool for diagnosing offending vessel in trigeminal neuralgia (TN) and Hemifacial spasms (HFS). Aim: To find out if Computational FluidDynamics (CFD) can correctly predict the offending vessel in HFS and TN & thus improving the outcome of Microvascular Decompression) MVD. Settings and Design: CFD is a relatively new mode of imaging. Its application to indicate offending vessel in TN & HFS was tested. Materials & Methods: Retrospectively we studied 13 consecutive patients operated in 2017 for either HFS or TN. Preoperatively MRI & Computed Tomography Angiogram (CTA) were done and the offending vessel identified along with its point of contact with the concerned nerve. CFD was done using Hemoscope 2015 software and wall pressure, wall shear stress, vector & streamline flow were obtained in the offending vessel (test) & contralateral vessel (control). Results of these were charted on an excel sheet & results analyzed. The postoperativeoutcome were assessed and compared with CFD results. Statistical analysis used: Small study group hence statistical analysis couldn’t be applied. Results: Of the 13 patients, offending artery had high wall pressure in 12 and increased wall shear stress innine. Among the controls six had high wall pressure and only two had high wall shear stress. Conclusion: CFD can be used to determine offending vessel and can predict good outcome following microvascular decompression.

Computational Fluid Dynamics Analysis of Trigeminal Neuralgia Associated with the Vertebral Artery: A Report of Two Cases

“…Recent studies have indicated the involvement of CFD in neurovascular compression syndrome. 12 13 14 Satoh et al retrospectively analyzed the offending artery of 20 symptomatic TN and hemifacial spasm patients. They reported a relatively high magnitude of WSS at NVC compared with the surrounding site of NVC.…”

Computational Fluid Dynamics Analysis of the Offending Artery at Sites of Neurovascular Compression in Trigeminal Neuralgia Using Preoperative MRI Data

“…Recent studies have indicated the involvement of CFD in neurovascular compression syndrome. 25–27) Satoh et al 26) retrospectively analyzed the offending artery of 20 symptomatic TN and hemifacial spasm patients and reported a relatively high magnitude of WSS and restriction of WSS directional movement along the NVC compared with the surrounding site of NVC. According to this study, a high WSSR, which indicates focal elevation of WSS at the NVC site, has the potential to identify symptomatic compressions.…”

“…However, unlike recent CFD studies using computed tomography angiogram for the construction of artery models, 25–27) the CFD technique used in this study is based on non-contrast-enhanced preoperative MRI, which is a simple and completely non-invasive method that provides useful information about the pathogenicity of NVC. This CFD technique should be considered during preoperative simulation of MVD.…”