Minimally invasive anatomic research of microvascular decompression for trigeminal nerve utilizing virtual reality technique

Abstract

Objective To discuss the microanatomy features of microvascular decompression for trigeminal nerve through minimally invasive approach based on virtual reality image models. Methods CT and MRI scans were performed to five adult cadaver heads, and then, image data were inputted into vitrea virtual reality system to establish three-dimensional anatomy models of cerebellopontine angle. Suboccipito-retrosigmoidal approach was simulated by selecting asterion as osseous landmark points of craniotomy and cistern segment of trigeminal nerve as exposed target. Anatomic exposures in surgical trajectory were observed and measured before and after minimally invasive design, respectively. Results Routes simulating microvascular decompression for trigeminal nerve through suboccipito-retrosigmoidal approach passed under the inferior edge of transverse sinus. Spacial relationship among route and surrounding nerves and vessels were displayed clearly. Measurement and comparative analysis among different routes indicated the volumes of routes: route b>route c> route a, and involved cerebellar volumes: route a>route c> route b. Conclusion Minimally invasive routes of suboccipito-retrosigmoidal approach can reduce surgical injure without sacrifice of anatomic exposure in microvascular decompression for trigeminal nerve. Key words: Trigeminal nerve; Microvascular decompression; Virtual reality; Three-dimensional anatomy; Minimal invasion