三叉神经痛术前磁共振断层血管成像结果与微血管减压手术疗效的对比研究

Comparison of MRTA imaging results and clinical outcomes of trigeminal neuralgia patients after microvascular decompression

目的探讨三叉神经痛术前磁共振断层血管成像（magnetic resonance tomographil angiography，MR-TA）结果与微血管减压（microvascular decompression，MVD）手术疗效的关系。方法回顾性分析167例三叉神经痛MVD术前MRTA影像学检查资料，结合手术所见压迫血管的类型，对比分析MRTA中有无责任血管与手术预后的关系。患者术后获6个月~6年随访，平均3.5年。随访结果按优、良、差进行分类。结果144例术前MR-TA阳性患者的预后明显好于23例术前MRTA阴性的患者（P〈0.01）。术中为单一动脉压迫患者的预后明显好于有静脉参与压迫或未发现责任血管压迫的患者（P〈0.01）。术前MRTA阴性且预后差的7例中，4例为单纯静脉压迫，3例神经根周围未见责任血管而仅有蛛网膜增厚粘连。结论非动脉压迫因素是三叉神经痛预后不良的重要因素之一。MRTA有助于术前判断MVD手术的预后，为术前筛选手术病人提供有效的方法。

Objective This study was performed to investigate the role of magnetic resonance tomography angiography（MRTA） imaging in prognosticating the outcomes of trigeminal neuralgia patients treated with microvascular decompression （MVD）. Methods We examined the preoperative MRTA images obtained between January 2001 and October 2006 for 167 patients with trigeminal neuralgia. These patients were followed up postoperatively for 6 months to 6 years with an averaging of 3. 5 years. The outcomes of MVD were graded as Excellent,Good or Poor and compared with the surgical findings and MRTA imagings. Results The MRTA imag- ings were positive in 144 cases and negative in 23. The clinical outcomes of MRTA-positive group was significantly better than MRTA--negative group （P〈0. 01）, and the single--artery compression cases were also significantly better than the venous （alone or in association with arteries） compression or no neuro--vascular conflicting cases （P〈0.01）. In the MRTA--negative group, there were 7 cases graded as ＂Poor＂. Among which 4 cases had pure--venous compression and remaining 3 cases had no neuro--vascular conflict finding. Conclusion Venous compression and no neuro--vascular conflict are bad prognostic factors. MRTA imaging can provide information which plays an important role in predicting the clinical outcomes.