磁共振断层血管成像对血管性三叉神经痛的临床应用研究

Clinical Study of MRTA in Vascular Trigeminal Neuralgia

目的对照分析三叉神经痛和面肌痉挛的磁共振断层血管成像(magnetic resonance tomographic angiography,MRTA)表现及手术结果,探讨MRTA在诊断三叉神经痛和面肌痉挛血管神经压迫中的价值。方法经临床诊断三叉神经痛53例,面肌痉挛42例,行MR三维时间飞越稳态梯度回波序列(3D-TOF-SPGR)采集图像,利用原始图像对两侧三叉神经和面神经进行轴位、矢状位和冠状位重建,观察血管与神经的关系,并与手术结果进行对照分析。结果53例三叉神经痛中,有48例MRTA重建显示明确的异常血管,存在血管压迫或接触三叉神经,阳性率为90.56%。42例面肌痉挛中有40例MRTA显示了面神经起始段有微血管跨越或对面神经有轻微的推压改变,阳性率为95.24%(40/42),与手术结果有较高的一致性。结论MRTA对发现三叉神经痛和面肌痉挛血管神经压迫具有重要价值,MRTA原始图像及斜矢状位和冠状位重建是显示神经血管接触的敏感方法,对选择手术方式具有重要指导意义。

Objective To compare the performance of magnetic resonance tomographis angiography with operation results of trigeminal neuralgia and hemifacial spasm and to evaluate the value of magnetic resonance tomographie angiography（MRTA） in diagnosis of neurovaseular compression resulting in trigeminal neuralgia and hemifacial spasm.Methods 53 cases of trigeminal neuralgia and 42 cases of hemifaeial spasm were examined using Three-dimensional（3D）time-of- flight（TOF）spoited gradient-eeho（SPGR） sequence. Oblique sagittal and coronal views were reconstructed to identify the relationship between facial or trigeminal nerves and surrounding vessels.Results From the MRTA images, 48 out of 53（90.56%） trigeminal neuralgia cases had vascular compression or contact and 40 in 42 hemifacial spasm cases had vascular compression or contact（95.24%）. The coincidence between MRTA and surgery was 95.6%.Conclusion MRTA has important value in diagnosis of neurovascular compression resulting in trigeminal neuralgia and hemifacial spasm. The original image,oblique sagittal and coronal reconstruction of MRTA are sensitive to demonstrate neurovascular compression, which play an important role in choosing surgical planning.