面肌痉挛的3.0T 3D-TOF MRA表现分析及病因诊断

The imaging characteristics and etiological diagnosis via 3.0T magnetic resonance angiograph in patients with hemifacial spasm

目的探讨面肌痉挛的3.0T3D-TOF-MRA表现及病因诊断。方法回顾性分析48例面肌痉挛患者术前3D-TOF-MRA图像,观察血管与面神经的毗邻关系,判明责任血管,并与术中所见血管与面神经的毗邻关系进行对照分析。结果 48例患者术中均找到责任血管:术前3D-TOF-MRA判明责任血管46例(95.8%),与术中所见相一致;2例(4.2%)责任血管来源不明;面神经受压位置在神经根出脑干处(REZ)44例(91.7%),在面神经中1/3段1例(2%),在外1/3段3例(6.3%);患侧与健侧均有血管压迫者31例,邻近血管的粗细和血管是否成袢是引起面肌痉挛的主要因素,对是否产生症状具有统计学意义(P<0.05)。结论 MRA发现有血管与面神经毗邻未必一定产生面肌痉挛的症状,只有将MRA所见责任血管与面神经的毗邻关系同临床症状相结合,才能对显微外科血管解压术(MVD)的成功实施提供重要的指导意义。

[Abstract] Objective To investigate the imaging characteristics and etiological diagnosis via the 3.0 T magnetic reso- nance angiography （MRA） in patients with hemifacial spasm. Methods MRA manifestations of 48 patients with hemifa- cial spasm were reviewed retrospectively. The relationship between facial nerves and peripheral vessel were observed to de- tect offending vessel, and operation results were compared. Results 3D-TOF-MRA showed the responsibility vessel ac- cordance with the surgery results in 46 of 48 patients （95.8%）, and 2 cases （4.2%） showed offending vessel of unknown origin. 44 cases （91.7%） presented neurovascular compression in the root entry zone （REZ）, and 1 patient was found neurovascular compression in the middle section of 1/3（2%）, and 3 had lateral 1/3 section （6.3%）. Neurovascular com- pression was found in both symptomatic and asymptomatic side in 31 patients. The diameter and mesh of blood vessel showed statistical significancy in the symptom of hemifacial spasm （ P 〈0.05）. Conclusion MRA discovery of vascular and nerve adjacent may not necessarily produce hemifacial spasm symptoms, only the MRA showed responsible vessel in combination with facial nerve abutting relationship with clinical symptoms can provide important guiding significance for the implementation of microsurgical vascular decompression （MVD）.