Three-dimensional reconstruction of the facial nerve course in parotid gland tumor using double echo steady state with water-excitation magnetic resonance images

Functional preservation of the facial nerve (FN) is essential in parotid tumor surgery. Recently, direct visualization of the FN in the parotid gland (double-echo steady-state sequence with water excitation magnetic resonance imaging [DESS-WE-MRI]) has been attempted with promising diagnostic accuracy. In this report, we present three-dimensional (3D) reconstruction of the FN course in two parotid gland tumor cases using DESS-WE-MRI images for the first time. One patient had a recurrent benign parotid gland tumor, while the other patient had a malignant parotid gland tumor. Regions-of-interest including the FN and the tumors were manually selected in each section of the DESS-WE-MRI images. The 3D renderings were then created with an In-Vesalius software. The FNs were well-demarcated to the temporofacial and cervicofacial branches. This virtual reconstruction of the FN nerve course can provide comprehensive and immediate understanding of the anatomical relationship between tumor and the FN, even for surgeons unaccustomed with DESS-WE-MRI images.