3.0 T MRI 3D-TOF序列联合3D-FIESTA序列结合多平面重建在三叉神经微血管减压术术前评估中的应用价值

Evaluation of 3D-TOF and 3D-FIESTA combined with MPR in microvascular decompression for trigeminal neuralgia by 3.0 T MRI system

目的探讨3.0 T MRI 3D-TOF序列联合3D-FIESTA序列结合多平面重建在三叉神经微血管减压术术前评估中的应用价值。材料与方法回顾性分析187例湘雅医院原发性三叉神经痛行三叉神经微血管减压术(MVD)的病例资料,将术前3D-TOF序列联合3D-FIESTA序列检查情况与术中探查结果进行对比研究。结果 187例患者术前3D-TOF序列联合3D-FIESTA序列显示:症状侧三叉神经血管压迫(neurovascular compression,NVC)阳性173例,阳性率达92.3%,MVD术发现血管神经压迫179例,阳性率达95.6%。其中小脑上动脉73例(40.8%)、小脑前下动脉28例(15.4%)、基底动脉17例(9.8%)、小脑后下动脉5例(3.2%)、复合压迫35例(20.2%)、静脉11例(6.2%)。3D-TOF序列联合3D-FIESTA序列显示无血管压迫14例,阴性率7.7%,而术中发现无责任血管10例,阴性符合率58.8%。症状对侧血管压迫阳性20例,假阳性率10.7%,两侧阳性率差异有统计学意义(P<0.05)。结论 3D-TOF序列联合3D-FIESTA序列,结合3D后处理重建能相对清晰显示三叉神经与周围血管的空间关系,是三叉神经微血管减压术术前评估的有效方法之一。

Objective： To investigate the value of 3D-TOF and 3D-FIESTA for preoperative assessment in microvascular decompression for trigeminal neuralgia. Materials and Methods： 187 cases of primary trigeminal neuralgia underwent microvascular decompression （MVD） of Xiangya Hospital were retrospectively analyzed, the 3D-TOF and 3D-FIESTA findings preoperative and the intraoperative exploration results were compared. Results： 3D-TOF and 3D-FIESTA identified surgically verified neuro-vascular compression in 173 of 187 （92.3%） symptomatic nerves. Neurovascular compression was observed in 29 of 187 （16%） of asymptomatic nerves, 179 cases （95.6%） which neurovascular compression （NVC） were observed during operation underwent MVD：73 cases （40.8%） with SCA, 28 cases （15.4%） with AICA, 5 cases （3.2%） with PICA, 17 caces with BA （9.8%）, 35 cases （20.2%） with compounding compression, 11 cases （6.2%） with vein. 3D-TOF and 3D-FIESTA were not identified in 14 cases （7.7%）, of which NVC 10 cases （58.8%） weren＆#39;t observed during operation underwent trigeminal rhizotomy. Before operations, the 187 cases ifndings of 3D-TOF combined with 3D FIESTA sequence demonstrated that 173 in 187 （92.3%） were neuro-vascular compression which were ipsolateral with the symoptoms. The procedures of microvascular decompression revealed that 179 in 187 （95.6%） were neuro-vascular compression, including that 73 （40.8%） cases with SCA, 35 （20.2%） cases with combined compression, 28 （15.4%） cases with AICA, 17 （9.8%） cases with BA, 11 （6.2%） cases with vein, 5 （3.2%） cases with PICA. Conclusions：3D-TOF and 3D-FIESTA combined with 3-D MPR which can clearly display spatial relationship of trigeminal nerve and around vessels is an effective method for preoperative assessment in microvascular decompression for trigeminal neuralgia.