三叉神经痛影像学因素与显微血管减压术后复发的相关性研究

The relationship between postoperative recurrence of microvascular decompression and the radiological factors of trigeminal neuralgia

目的 评价原发性三叉神经痛显微血管减压术（MVD）术后复发的相关影像学因素.方法 分析接受MVD治疗的107例患者临床资料和术前MRI影像学资料与术后复发的关系.三叉神经影像学因素包括：CPA面积比、TGN截面积比、TGN长度比、TGN夹角比、压迫点距离和方位、基底动脉位置、责任血管类型.结果 Kaplan-Meier单因素分析：病程（P=0.039）、临床特征（P=0.049）、CPA面积比（P=0.003）、责任血管类型（P=0.000）、TGN截面积比（P=0.036）、压迫点距离（P=0.045）与术后复发相关（P＜0.05）;多因素COX回归分析：病程（P=0.002）、CPA面积比（P =0.049）、责任血管类型（P=0.000）、TGN截面积比（P=0.019）是影响MVD术后复发的因素（P＜0.05）.结论 病程短并且三叉神经术前MRI提示CPA池无狭窄、责任血管为动脉、神经根无萎缩的患者MVD术后不容易复发.

Objective To evaluate the radiological factors about the recurrence of primary prosopalgia treated by microvascular decompression （MVD）.Methods To analyze the relationship between postoperative recurrence and preoperative MRI features of the 107 patients who were treated by MVD in Nanfang hospital.The radiological characteristics of trigeminal nerve （TGN） included the sectional area ratio,length ratio,intersection angle ratio,compression distance and orientation of TGN.Besides that,the radiological features also included the area of cerebellopontine angle （CPA）,location of basilar artery and the types of offending vascular.Results The result of Kaplan-Meier analysis showed the duration of disease（P =0.039）,clinical presentation（P =0.049）,the area ratio of cerebellopontine angle （P =0.003）,types of offending vascular （P =0.000）,sectional area ratio of TGN （P =0.036） and compression distance of TGN （P =0.045） were related to the postoperative recurrence（P ＜0.05）.The Cox Regression showed that the area ratio of CPA （P =0.049）,duration of disease （P =0.002）,offending vascular types （P =0.000） and sectional area ratio of TGN （P =0.019） were the main influencing factors of postoperative recurrence（P ＜ 0.05）.Conclusions The MRI characteristics of TGN demonstrated that the CPA cistern without stenosis,the offending vascular being artery and the nerve root without atrophy will not easily lead to the postoperative recurrence of MVD.