Three-dimensional visualization of neurovascular compression: Presurgical use of virtual endoscopy created from magnetic resonance imaging. Comment.

With this well-illustrated article, Takao et al. described the utility of presurgical simulation of microvascular decompression by virtual endoscopy, a new tool to analyze three-dimensionally reconstructed magnetic resonance data sets, in 17 patients with trigeminal neuralgia or hemifacial spasm. It is known that not every individual with evidence on neuroradiological studies of a suspected neurovascular conflict is clinically symptomatic, but, when a patient has trigeminal neuralgia or hemifacial spasm and also has preoperative evidence of a conflict, this fact is very important in deciding the best treatment strategy. Having the ability to study the surgical anatomy of the conflict preoperatively and even to virtually navigate in the cerebellopontine angle helps in determining the optimal depiction of the deformity of the trigeminal nerve at the compression site and the presence of perforating arteries, if any, that might make the operation more dangerous. The comparison of the virtual endoscopy images with the actual surgical images, which demonstrate the value of the preoperative studies, makes the present study quite interesting.