无血管压迫影像表现的三叉神经痛患者的颅内原因初探

No Vascular Compression of the Image on the Causes of Intracranial Trigeminal Neuralgia Patients

目的：分析磁共振断层血管成像（magnetic resonance tomographic angiography，MRTA）阴性结果的原因。方法：回顾性分析2003年3月～2011年12月期间临床诊断为原发性三叉神经痛并行MVD手术患者共341例，将术前MRTA及术中内镜对比，对术前MRTA阴性的原因进行分类。结果：MRTA对判断血管神经压迫（neuro—vascular compression，NVC）有较高的敏感度92．4％（291／315），判断NVC的特异度为65．4％（17／26）。假阴性病例有24例，其中，内镜表现为岩静脉压迫9例，小脑上动脉12例，其分支2例，小脑下前动脉1例。17例真阴性病例中有3例蛛网膜增厚粘连，1例颞骨骨隆突，5例微小胆脂瘤压迫，8例无任何压迫。结论：MRTA阴性结果的原因主要有管径长度较小的动脉、血液流速较慢的静脉、蛛网膜粘连、颞骨骨隆突、微小胆脂瘤及其他不明原因（包括多发性硬化病等）。

Objective： To analyze negative results of MRTA. Methods： We retrospectively analyse a total of 341 cases of primary trigeminal neuralgia, who accepted MVD surgery during March 2003 -- December 2011. We classify preoperative MRTA negative reasons on the basis of comparison of the preoperative MRTA and intraoperative endoscopy image. Results： A higher sensitivity of 92.4% （291/315） and a speeifieity of 65.4% （17/26） for NVC was found in MRTA. There were 9 cases of petrosal vein, 12 cases of superior cerebellar artery, 2 cases of its branch and 1 case of anterior inferior cerebellar artery in 24 false negative cases. There were 3 cases of arachnoid adhesions, 1 case of temporal bone protuberance, 5 cases of little cholesteatoma and 8 cases of no oppression in 17 true negative cases. Conclusion： Main causes of negative results of MRTA invole smaller caliber length of artery, slow flow rate of vein blood, arachnoid adhesions, temporal bone protuberance, little cholesteatoma and other unknown causes （including multiple sclerosis）.