1250 Enhancing Surgical Planning for Microvascular Decompressions Using Extended Reality 3D Modeling and Visualization

INTRODUCTION: Trigeminal neuralgia (TN) and hemifacial spasm (HS) are commonly caused by a neurovascular conflict (NVC) in the nerve root exit zone, with offending vessels such as the superior cerebellar artery, anterior inferior cerebellar artery, and surrounding veins. Microvascular decompression (MVD) is a treatment option for NVC, and reliable identification of the complex relationship is imperative for operative success and outcomes. Preoperative planning using 2D radiographic images and limited 3D vascular reconstruction does not capture the optimal trajectory and operative viewpoints. Thus, extended reality (XR) 3D modeling could better simulate the intraoperative neurovascular structure. METHODS: We retrospectively analyzed 11 cases (6 TN and 5 HS) that were treated in our institute. Preoperative MRI with CISS sequence and MRA scans were fused and reconstructed using Surgical Theater by an independent team. All critical neurovascular structures pertinent to the NVC were segmented. The operative trajectory and viewpoints were simulated and compared to the intraoperative findings by the senior neurosurgeon. RESULTS: The preoperative XR simulations of the MVD using Surgical Theater provided a clear visualization of the anatomical relationships of the NVC in 10/11 cases. The offending arteries or veins could be easily identified and mapped onto the 3D volumetric model within the XR planning platform. The preoperative prediction following the planned trajectory and viewpoint matched precisely with the intraoperative visualization of the NVC in 10/11 cases. CONCLUSIONS: 3D XR modeling technology, such as Surgical Theater, serves as a powerful preoperative planning and intraoperative prediction tool. Dynamic visualization and interaction with the 3D models are critical for understanding the complexity within each NVC and establishing the most optimal MVD approach for treating TN or HS.