"FIESTA-3D now is our preferred sequence for all the IAC and trigeminal nerve studies, as it brings altogether an outstanding CSF versus nerve & vessel contrast, a very high spatial resolution in 3D, in a shorter scan time than any conventional 3D sequence."

Background
The external clinical signs of a neurovascular conflict involving facial nerves are clear and well established. The efficiency and safety of any surgical treatment relies on the ability to depict the anatomy and trajectory of nerve & vessel in conflict, with an imaging technique providing a high contrast capability for both nerve & vessel regarding the surrounding CSF. CT does not provide adequate depiction of the nerves. MR has the potential to show both nerve and vessel, but the challenge still resides in the ability to have such a contrast in a high-resolution 3D acquisition within a reasonable scan time. The new FIESTA 3D* sequence addresses these needs, while maintaining the scan time below 5 minutes.

Case Study
We demonstrate the case of a female patient, suffering from left side facial pain. The examination included a 3-Plane localizer, an Axial T2 FSE, and an Axial FIESTA-3D. The spatial resolution achieved was 0.7x0.7mm in plane, and 1mm through-plane, with 512 and slice "ZIP" interpolations. The scan time for 64 acquired slices was 5 minutes 19s. The Fig. 1 image shows the conflict between the left trigeminal nerve and the left branch of the superior cerebellar artery (arrow). The Fig. 2 images show the whole vessel & nerve path along the inferior to superior direction.

Figure 1	Figure 2

Figure 3: Reformation showing a nerve (green arrow) & vessel (orange arrow).

Figure 4: Curved reformation along the left superior cerebellar artery showing the portion of the vessel in contact with the left trigeminal nerve.

Figure 5: The red curved line shows the trajectory followed with Curved Reformat.

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