Augmented reality-assisted microvascular decompression for glossopharyngeal neuralgia: a case report

Abstract

Glossopharyngeal neuralgia is a rare condition characterized by pain along the distribution of the glossopharyngeal nerve. Surgical approaches via microvascular decompression represent a common treatment strategy. For this procedure, an understanding of the location of the cranial nerve and the offending vasculature is critically important. A mixed reality system was used to register patient-specific 3D models onto the patients head for operative planning and anatomical visualization. A 58-year-old female presented to neurosurgery with severe right-sided facial, tongue, and jaw pain unresponsive to multiple conservative therapies including medication. T2-weighted MRI with FIESTA sequence demonstrated right posterior inferior communicating artery compression of the right glossopharyngeal nerve entry zone. An augmented reality system was used to visualize the patients' anatomy overlaid onto the patients' head. A microvascular decompression of Cranial Nerves IX and X was performed via a retrosigmoid approach. Patient obtained significant relief of preoperative pain symptoms without complications.

Keywords: augmented reality; glossopharyngeal neuralgia; microvascular decompression.

Figure 1

T2-weighted MRI with FIESTA sequence demonstrated right PICA compression of the right glossopharyngeal nerve entry zone demonstrating the axial and sagittal view. Arrow demonstrates location of neurovascular compression.

Figure 2

Overview of augmented reality system work flow. The process begins with segmentation of relevant anatomy followed by generation of a patient-specific 3D anatomical models. Using the headset, a surgeon registers the 3D model onto the patients’ head using a fiducial-less approach allowing for visualization of the 3D model overlaid onto the patients’ head.

Figure 3

Representative views through the AR headset of 3D models overlaid onto the patient’s head from different perspectives. Brain (blue/orange), vasculature (red), cranial nerves (yellow), and brainstem (white).