面肌痉挛患者术前磁共振断层血管成像检查结果与术中所见的对比研究

Preoperative etiological diagnosis of hemifacial spasm: a comparative study between magnetic resonance tomographic angiography and intra-operative findings

目的 回顾性总结磁共振断层血管成像 (MRTA)影像技术在面肌痉挛术前病因诊断中的价值。方法 1998年 6月至 2 0 0 3年 2月 ,对 336例面肌痉挛患者进行了术前常规MRTA检查。 336例中男 12 7例 ,女 2 0 9例 ,年龄 16～ 75岁 ,平均 4 6 2岁。除 1例症状为双侧外 ,其余均为单侧 ,其中左侧 2 14例、右侧 12 1例。发病时间 1～ 2 9年 ,平均 6 2年。双盲读片作面肌痉挛病因诊断并与术中所见进行比较。结果 336例患者MRTA显示 ,器质性病变 3例 ,其中桥脑小脑角脑膜瘤 1例、表皮样囊肿 2例。发现症状侧存在责任压迫血管者 2 73例 ,阳性率达 81 3% ,均由手术证实。症状对侧或双侧有可疑压迫血管 2 7例 ,假阳性率为 8 0 %。MRTA未显示压迫血管 33例 ,阴性率 9 8% ;阴性的 33例中在手术时发现存在责任血管 30例 ,阴性符合率仅 9% ,提示MRTA阴性并非手术反指征。结论 MRTA检查是面肌痉挛术前病因诊断的一种有效、无创的影像学检查方法。它不仅可发现面肌痉挛的器质性病因 ,还可显示微血管压迫的存在及其来源 ,具有很高的阳性符合率 ,有助于术前对手术难易度的评估和术中对责任血管来源及走向的把握。

Objective To summarize retrospectively the value of magnetic resonance tomographic angiography (MRTA) in the preoperative etiological diagnosis for hemifacial spasms (HFS). Methods 336 cases of HFS,127 male and 209 female,aged 46.2 (16～75), with a course of 1～29 years (6.2 years on average) and with the unilateral symptoms except one case were subjected to routine MRTA check up preoperatively. The MRTA findings were compared with the operative findings. Results Pre-operative evaluation by MRTA discerned 273 offending vessels with a positive rate of 81.3%,which were completely consistent with the intra-operative findings. The false positive and false negative rates were 8.0% and 9.8% respectively. Three cases of HFS due to secondary cause were found: one of CPA meningioma at the cerebellopontine angle and two cases of cholesteatoma. Conclusion MRTA imaging provides more useful information concerning the etiology of hemifacial spasm than any other available diagnostic modalities. It is an effective and reliable means for pre-operative evaluation of the existence and sources of offending vessels in hemifacial spasm patients, and thus benefits the planning and guiding of intra-operative manipulation.