探讨3D-FIESTA和3D-TOF在三叉神经痛微血管减压术中的指导意义及临床价值

The guiding significance and clinical value of 3D-FIESTA and 3D-TOF in microvascular decompression for trigeminal neuralgia

目的探讨三维稳态进动快速成像序列(3D-FIESTA)和三维时间飞跃法(3D-TOF)在三叉神经痛微血管减压术中的指导意义及临床价值。方法回顾性分析86例三叉神经痛微血管减压术患者术前MRI及术中影像,分析3D-FIESTA和3D-TOF-MRA序列在三叉神经痛患者与责任血管的关系以及其临床意义。结果本组86例患者证实83例(96.5%)存在血管神经关系密切,以术中所见影像为金标准。术前均采用3D-FIESTA和3D-TOF-MRA序列。本组78例患者至目前无明显症状,2例再次手术,1例术后面部麻木无疼痛,1例术后出现颅内感染症状经抗感染治疗后痊愈,2例面部间断性轻度疼痛且拒绝口服药物(患者自述不影响正常生活),未给予特殊处理,1例遗漏轻度面瘫。1例失访。结论术前3D-FIESTA和3D-TOF-MRA检查能够清晰识别三叉神经痛患者神经血管的关系,对指导微血管减压术以及预测手术难易度有重要的临床意义。

Objective To investigate the guiding significance and clinical value of 3D- FIESTA and 3D- TOF in microvascular decompression for trigeminal neuralgia. Methods Preoperative MRI and intraoperative images on 86 patients with microvascular decompression for trigeminal neuralgia were retrospectively analyzed. Meanwhile,the roles of 3D- FIESTA and 3D- TOF- MRA on the relationship between nerves and responsible vessels in trigeminal neuralgia patients as well as the clinical significance were analyzed. Results A total of 86 cases in this group had confirmed that 83 cases existed a close relationship between blood vessels and nerves,regarding intraoperative images as golden standard. 3D- FIESTA and 3D- TOF- MRA were adopted before operation. All patients in this group showed efficiencies after operation and so far 78 cases had no significant symptom; 2 patients received the operation again; 1 case had facial numbness without pains; 1 case had intracranial infection after operation and cured with anti- infective therapy; 2 cases had facial intermittent mild pain and refused to take oral drugs（ patients had stated those pains did not affect normal life）,without special treatments; 1 case had mild facial paralysis and 1 case was lost to follow up. Conclusion Preoperative 3D- FIESTA and 3D- TOF- MRA can clearly reveal the relationship between nerves and blood vessels in trigeminal neuralgia patients,which is of vital clinical significance in guiding microvascular decompression and predicting operation difficulty.