磁共振断层血管成像在三叉神经痛及面肌痉挛术前评估中的应用价值  

Usefulness of MRTA on Preoperative evaluation in patients with trigeminal neuralgia and hemifacial spasm

作　　者：郑兆聪[1] 陈自谦[1] 王如密[1] 高进喜[1] 陈宏颉[1] 魏梁锋[1] 洪景芳[1] 

机构地区：[1]福州总医院神经外科

出　　处：《福州总医院学报》2009年第1期18-20,F0003,共4页Journal of Fuzhou General Hospital

摘　　要：目的:评价磁共振断层血管成像(magnetic resonance tomographic angiography,MRTA)显示桥小脑角区脑神经与血管的三维空间关系的能力及对血管压迫性三叉神经痛和面肌痉挛病因诊断的价值。方法:回顾性分析210例患者(其中三叉神经痛178例,面肌痉挛32例)术前MRTA影像学表现及微血管减压(microvascular decompression,MVD)术中所见责任血管结果。结果:MRTA重建可以直观地显示桥小脑角脑神经与血管的三维立体的图像,再现局部脑神经与血管解剖结构。210例症状侧术前MRTA检查有血管压迫者为157侧,血管与神经接触密切者为35侧,共192侧,敏感性为91.4%。手术中发现有血管压迫或接触者202侧,其中动脉责任血管187侧,静脉责任血管9侧,动静脉双重责任7侧。MRTA检查诊断神经血管压迫和接触的特异性分别为98.7%(155/157)和94.3%(33/35),其余4侧仅见蛛网膜增厚,而血管与神经之间接触不密切。MRTA未能发现但手术中证实存在血管压迫或接触者14侧,其责任血管均为静脉或小动脉。结论:高分辨MRTA成像结合3D后处理重建能清晰显示三叉神经和面听神经脑池段与周围血管的空间关系,对明确三叉神经痛或面肌痉挛的病因诊断有重要价值,可为术前筛选手术病人及优化MVD手术提供可靠的影像学依据。Objective： To evaluate the magnetic resonance tomographic angiography （MRTA） findings On the capability to display there - dimension spatial relationship of cranial nerves and vascular in cerebellopontine angle, and its etiological diagnostic values in patients with vascular compressive trigeminal neuralgia （TN） and hemifacial spasm. Method： We analyzed retrospectively the preoperative MRTA images for 178 patients with trigeminal neuralgia and 32 patients with hemifacial spasm and their operative findings of responsible vascular. Results： MRTA may allows clear visualization of three- dimensional images of nerves and vascular in cerebellopontine angle, and reproduces anatomic structures such as osmial nerves and vascular. Neurovascular compression （NVC） was identified on MRTA in 157 out of 210 symptomatic nerves, neurovascular contact in 35 cases, with total sensitivity rate was 91.4%. Operative findings confirmed NVC or nerorvescular contact in 202 cases, of which the offending vessels were： arteries alone in 187 cases, venous alone in 9 cases, venous in association with arteries in 7 cases. The sensitivity rate was 98.7% （155/157） and 94.3% （33/35） in patients with trigeminal neuralgia and bemifacial spasm, respectively, only arachnoid membrane thickening but not NVC were found in the rest 4 cases. Operation found offending vescnlars to be venous or small arteries in 14 cases while MRTA showed negative. Conclusion： Fusion imaging of high- resolution MRTA and reconstructed 3D may allows clear visualization of spatial relationship of trigeminal nerves/facial nerve and surrounding vascular structures, and play an important role in identifying etiological diagnosis of trigeminal neuralgia （TN） and hemifacial spasm. It may also provides reliable imaging for preoperative selection of patients and optimizing MVD procedures.

关 键 词：磁共振断层血管成像 三叉神经痛 面肌痉挛 微血管减压术 

分 类 号：R745[医药卫生—神经病学与精神病学] R745.11[医药卫生—临床医学]