血管与神经三维动态同步重建在原发三叉神经痛微血管减压术中的应用

Application of three dimensional dynamic simultaneous reconstruction of blood vessels and nerves in microvascular decompression for primary trigeminal neuralgia

目的探讨血管与神经三维动态同步重建在原发性三叉神经痛微血管减压术中的应用价值。方法本课题实验组和对照组各36例分别行颅脑磁共振血管成像(3D-TOF)及(3D-ciss)检查。实验组利用3Dslicer软件对两序列原始数据进行同步重建出血管与神经三维动态图像,与术中探查的神经、责任血管的位置关系进行分析比较。并与对照组(仅行磁共振血管成像(3D-TOF)及(3D-CISS)检查,未利用3Dslicer软件同步重建出血管与神经三维动态图像)36例患者进行减压时间、术中平均出血量、术后联合疼痛缓解程度及术后并发症对比。结果实验组及对照组72例患者中,实验组利用3Dslicer软件同步重建出血管与神经三维动态图像,显示血管神经压迫症状侧阳性率94.4%(34/36);对照组36例原发性三叉神经痛患者在(3D-TOF)及(3D-ciss)序列图像上显示血管神经压迫症状侧阳性率91.7%(33/36)。实验组术前影像学诊断与手术探查结果符合率为97.22%(35/36),对照组术前影像学诊断与手术探查结果符合率为88.88%(32/36)。实验组与对照组在减压时间(t=9.893,P<0.05)、术中平均出血量(t=4.258,P<0.05)、术后联合疼痛缓解程度(Z=6.771,P<0.001)有明显差异,术后并发症无差异。结论血管与神经三维动态同步重建可多角度地显示三叉神经与邻近血管空间关系,对三叉神经痛微血管减压术术前评估、缩短游离责任血管、神经减压时间、减少术中出血量、提高术后联合疼痛缓解程度具有较高的应用价值。

Objective To study vascular and nerve 3ddynamic synchronous reconstruction in the application value of microvascular decompression（MVD）for the treatment of primary trigeminal neuralgia（PTGN）.Methods The experimental group and the control group with 36 cases in each group,and all the patients were performed brain MRI（3D-TOF and 3D-ciss）.In the experimental group,the original data of two kinds of sequences（3D-TOF and 3D-ciss）were used to reconstruct the 3Ddynamic images of blood vessels and nerves by the 3Dslicer software,but the control group were not.Results The results were analyzed and compared with the position relation of the nerve and the responsible vessels during the operation.Finally we find out the differences between the two groups in the operation time,the average amount of bleeding,postoperative pain relief degree and postoperative complications.The positive rate of vascular compression nerve was 94.4%（34/36）in the experimental group which were reconstructed the 3Ddynamic images of blood vessels and nerves by the 3Dslicer software,while the control group was91.7%（33/36）.Preoperative imaging diagnosis and surgical outcome were in accordance with the rate of 97.22%（35/36）in the experimental group,while the control group was 88.88%（32/36）.The two groups in operative time（t=9.893,P0.05）,average amount of bleeding（t=4.258,P0.05）,and postoperative pain relief degree（Z=6.771,P0.001）have obvious difference,but postoperative complication rate had no difference.Conclusion Vascular and nerve 3ddynamic synchronous reconstruction can be used to show the spatial relationship between the trigeminal nerve and the blood vessel from a number of angle,and has an excellent and applied value in the preoperative evaluation of MVD,shorten the operation time,reduction of the blood loss during the operation,and the improvement of postoperative pain relief degree.