舌咽神经痛的MR征象分析

Glossopharyngeal neuralgia:MR findings

目的探讨 MRI 对舌咽神经和周围血管的显示能力以及对舌咽神经痛诊断的意义。方法回顾性分析12例舌咽神经痛患者 MR 征象,与手术所见和术后症状改善对照。结果 10例舌咽神经根部受动脉血管压迫或与之接触,其中9例 MRI 上有相应征象,1例 MRI 未能显示责任血管。1例舌咽神经根部受静脉压迫,MRI 未能显示责任血管。1例手术发现舌咽神经周围有明显的蛛网膜粘连,MRI 上无相应征象。MRI 发现症状侧舌咽神经受小脑后下动脉或椎动脉压迫或与之接触者分别为8和1例;除1例手术确定小脑前下动脉为责任血管外,其他手术与 MRI 所见一致;MRI 未发现症状侧舌咽神经受血管压迫或与之接触征象者3例,术中1例见到未能确定来源的小动脉压迫舌咽神经根部,1例小静脉压迫舌咽神经根部,1例舌咽神经周围有明显的蛛网膜粘连。并发同侧三叉神经痛的8例,6例症状侧 MRI 发现三叉神经根部受小脑上动脉压迫或与之接触,其中5例手术与MRI 所见一致,1例手术未能确定责任小动脉来源;MRI 未发现症状侧三叉神经受血管压迫或与之接触征象的2例,术中1例见脑干引流静脉压迫三叉神经根部,1例未见有血管压迫。行舌咽神经根和三叉神经根微血管减压术后,所有患者疼痛消失。结论 MRI 能显示舌咽神经与毗邻动脉血管之间的关系,对舌咽神经痛病因分析和治疗方法选择有重要的意义。

Objective To investigate the possibility of MRI on visualizing the relationship between glossopharyngeal nerve and surrounding vessels, and to evaluate the significance of MRI in the diagnosis and treatment of glossopharyngeal neuralgia. Methods MRI findings were analyzed retrospectively in 12 patients with glossopharyngeal neuralgia, and were compared with surgical findings and effect of pain relief. Results The artery compression or contact of the glossopharyngeal entry zone, as revealed during operation in 10 patients with glossopharyngeal neuralgia, was visualized on MRI in 9 and not seen in 1. The venous compression of the glossopharyngeal entry zone was not identified on MRI in 1. The conglutinative arachnoids of the glossopharyngeal entry zone was not visualized on MRI in 1. MRI demonstrated the affected glossopharyngeal nerve root entry zone was compressed or contacted by the posterior inferior cerebellar artery （PICA） in 8 patients and by the vertebral artery in 1 patient. One patient＇s offending vessel was confirmed to be the anterior inferior cerebellar artery （AICA） by the operation, and the surgical findings were corresponded with MRI in others. Vascular compression or contact of the affected glossopharyngeal nerve was not visualized on MRI in 3 patients, and operation confirmed that the glossopharyngeal nerve root entry zone was compressed by unknown artery in 1, by small vein in 1, and by conglutinative arachnoids in 1, respectively. Eight patients presented with symptoms of the ipsilateral trigeminal neuralgia concurrently. The compression of the affected trigeminal nerve root by superior cerebellar artery （SCA） was visualized on MRI in 6 patients, and operation did not reveal the source of artery compression in 1 and corresponded with MRI findings in other 5 cases. Vascular compression of affected trigeminal nerve was not visualized on MRI in 2 patients, and intraoperative inspection revealed that trigeminal nerve root was compressed by draining vein of brainstem in 1 and not compressed by any vessels in 1. All patient＇s neuralgia resolved after microvascular decompression of glossopharyngeal nerve and trigeminal nerve. Conclusion It is possible to visualize the glossopharyngeal and surrounding arteries on MRI, and it is of great significance in the diagnosis and treatment of this kind of glossopharyngeal neuralgia.