血管压迫程度在三叉神经痛患者预后评估中的应用价值分析  

Applied value of vascular compression grading in prognosis evaluation of patients with trigeminal neuralgia

作　　者：刘定阳[1] 张恺 汪挺舰 杨转移[1] 陈晓宇[1] 蔡宇翔[1] 刘涧 王延金[1] 侯永宏[1] 杨治权[1] Liu Dingyang;Zhang Kai;Wang Tingjian;Yang Zhuanyi;Chen Xiaoyu;Cai Yuxiang;Liu Jian;Wang Yanjin;Hou Yonghong;Yang Zhiquan(Department of Neurosurgery,Xiangya Hospital,Central South University,Changsha 410008,China;Department of Neurosurgery,First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]中南大学湘雅医院神经外科,长沙410008 [2]南昌大学附属第一医院神经外科,南昌330006

出　　处：《中华神经医学杂志》2020年第11期1104-1108,共5页Chinese Journal of Neuromedicine

摘　　要：目的探讨术前MRI评估的原发性三叉神经痛(TN)患者三叉神经颅内段血管压迫程度对TN患者显微血管减压术(MVD)后预后的预测价值。方法回顾性分析中南大学湘雅医院神经外科自2015年1月至2017年12月行MVD术治疗的270例TN患者临床及MRI资料。参照Sindou等方法及Jannetta等标准,根据患者术前MRI资料将患者分为轻度血管压迫组患者(71例)及重度血管压迫组患者(199例),根据患者症状特点将其分为典型TN组患者(219例)及非典型TN组患者(51例),比较不同分组患者随访1年后的预后差异。结果术中所见血管压迫程度与术前影像学评估结果基本一致,256例患者术中所见符合术前影像评估分级,符合率为94.8%(256/270)。轻度血管压迫组患者与血管重度压迫组患者预后差异有统计学意义(Z=-3.420,P=0.001),平均秩次提示重度血管压迫患者预后优于轻度血管压迫患者(142.01 vs.117.25)。典型TN组患者与非典型TN组患者的预后差异有统计学意义(Z=-5.810,P=0.000),平均秩次提示典型TN患者预后优于非典型TN患者(144.45 vs.97.08)。结论术前MRI评估TN患者三叉神经颅内段血管压迫程度方法可靠,重度血管压迫患者及典型TN患者MVD术后疗效较好。Objective To investigate the predictive value of trigeminal nerve vascular compression grading evaluated by preoperative magnetic resonance imaging(MRI)in patients with trigeminal neuralgia(TN)after microvascular decompression(MVD).Methods Two hundred and seventy patients with TN accepted MVD in our hospital from January 2015 to December 2017 were chosen in our study;their clinical and MRI data were retrospectively analyzed.By referring to Sindou's method and Jannetta standard,these patients were divided into patients with mild vascular compression(n=71)and patients with severe vascular compression(n=199)according to preoperative MRI data;these patients were divided into typical TN patients(n=219)and atypical TN patients(n=51)according to their symptomatic characteristics;the differences in prognoses after one year of follow-up were compared among patients from different categories.Results The degree of intraoperative vascular compression was basically consistent with the preoperative imaging evaluation results,and the intraoperative vascular compression in 256 patients was consistent with preoperative imaging evaluation grading,with a coincidence rate of 94.8%(256/270).The difference in prognosis between patients with mild vascular compression and patients with severe vascular compression was statistically significant(Z=-3.420,P=0.001),and the mean rank indicated that the prognosis of patients with severe vascular compression was better than that of patients with mild vascular compression(142.01 vs.117.25).The prognosis difference between typical TN patients and atypical TN patients was statistically significant(Z=-5.810,P=0.000),and the mean rank indicated that the prognosis of typical TN patients was better than that of atypical TN patients(144.45 vs.97.08).Conclusions Preoperative MR imaging evaluation is a reliable method to assess the degree of vascular compression.Patients with severe vascular compression and typical TN have high postoperative pain relief rate after MVD.

关 键 词：三叉神经痛 显微血管减压术 神经血管压迫程度 预后 

分 类 号：R745.11[医药卫生—神经病学与精神病学]