Satoh Toru, Yagi Takanobu, Onoda Keisuke, Kameda Masahiro, Sasaki Tatsuya, Ichikawa Tomotsugu, Date Isao
1Department of Neurological Surgery, Ryofukai Satoh Neurosurgical Hospital, Fukuyama, Hiroshima.
2Center for Advanced Biomedical Sciences, Waseda University, Tokyo.
J Neurosurg. 2018 Jul 6;130(6):1870-1876. doi: 10.3171/2018.1.JNS172544. Print 2019 Jun 1.
Offending vessels at the site of neurovascular contact (NVC) in patients with trigeminal neuralgia (TN) and hemifacial spasm (HFS) may have specific hemodynamic features. The purpose of this study was to investigate the wall shear stress (WSS) of offending vessels at NVCs by conducting a computational fluid dynamics (CFD) analysis.
The authors retrospectively analyzed the cases of 20 patients (10 with TN and 10 with HFS) evaluated by 3D CT angiography and used the imaging findings for analysis of the hemodynamic parameters. The 3D CFD images were directly compared with the NVCs determined by simulated multifusion images of CT angiogram and MR cisternogram, and operative photos. The magnitudes of the WSS (WSSm) at the proximal (WSSm-p), just-beginning (WSSm-j), contact site (WSSm-s), and distal (WSSm-d) areas of each NVC were analyzed. The ratios of the WSSm-j, WSSm-s, and WSSm-d areas to the WSSm-p area were calculated individually. The direction of the WSS (WSSv) and its temporal variation (WSSvV) were depicted and morphologically compared with the NVC confirmed by simulated images and operative findings.
The ratios of WSSm at the just-beginning and the contact site to the proximal area of the NVCs (WSSm-j/WSSm-p and WSSm-s/WSSm-p) were both significantly higher than that at the distal area (WSSm-d/WSSm-p) (p < 0.05). The WSSv and WSSvV at the NVCs showed small variation in a single cardiac cycle, especially along the areas that were in contact with the affected nerve.
Areas of relatively high WSSm and temporal variation of WSSm (WSSmV) were observed at the NVCs. Less mobility of the WSSv and WSSvV was detected along the side of the vessels in contact with the nerves. These findings may be consistent with the actual area of the NVC. Hemodynamic features of the site of NVC can be added to the preoperative simulation for MVD surgery, which may be useful for the diagnosis and treatment planning of TN and HFS.
三叉神经痛（TN）和半面痉挛（HFS）患者神经血管接触（NVC）部位的肇事血管可能具有特定的血流动力学特征。本研究的目的是通过进行计算流体动力学（CFD）分析来研究NVC处肇事血管的壁面剪应力（WSS）。
作者回顾性分析了20例患者（10例TN患者和10例HFS患者）的病例，这些患者均接受了三维CT血管造影评估，并利用影像学检查结果分析血流动力学参数。将三维CFD图像与由CT血管造影和磁共振脑池造影的模拟多融合图像以及手术照片所确定的NVC直接进行比较。分析每个NVC近端（WSSm-p）、起始处（WSSm-j）、接触部位（WSSm-s）和远端（WSSm-d）区域的WSS大小（WSSm）。分别计算WSSm-j、WSSm-s和WSSm-d区域与WSSm-p区域的比值。描绘WSS方向（WSSv）及其随时间的变化（WSSvV），并与模拟图像和手术结果所证实的NVC进行形态学比较。
NVC起始处和接触部位的WSSm与近端区域的比值（WSSm-j/WSSm-p和WSSm-s/WSSm-p）均显著高于远端区域（WSSm-d/WSSm-p）（p<0.05）。NVC处的WSSv和WSSvV在单个心动周期内变化较小，尤其是在与受影响神经接触的区域。
在NVC处观察到WSSm相对较高的区域以及WSSm随时间的变化（WSSmV）。在与神经接触的血管一侧检测到WSSv和WSSvV的移动性较小。这些发现可能与NVC的实际区域一致。NVC部位的血流动力学特征可添加到微血管减压术（MVD）手术的术前模拟中，这可能对TN和HFS的诊断和治疗规划有用。
