TOF-MRA影像在面肌痉挛显微血管减压术中的应用价值分析

Role of time of flight magnetic resonance angiography in prognosis of hemifacial spasm after microvascular decompression

目的探讨术前时间飞越MRA（TOV-MRA）影像学在面肌痉挛显微血管减压术中的应用价值分析。方法陆军总医院附属八一脑科医院神经外科及杭州市萧山区第一人民医院神经外科自2013年1月至2013年8月采用显微血管减压术治疗的136例面肌痉挛患者，通过术前TOF．MRA影像学判断责任血管类型将患者分为椎动脉型面肌痉挛f44例）与小血管型面肌痉挛（92例），并根据术中所见回顾性分析2种类型面肌痉挛在显微镜下手术时间，预测手术难易程度、手术疗效及颅神经功能障碍发生率。结果术前TOF-MRA影像学特征同手术中所见椎动脉型与小血管型面肌痉挛相符：椎动脉型面肌痉挛显微镜下手术时间明显长于小血管型，比较差异有统计学意义（P〈0．05），预测椎动脉型面肌痉挛手术难度高于小血管型；而手术治愈率及缓解率比较差异无统计学意义（P〉0．05）；椎动脉型面肌痉挛术后颅神经功能障碍高于小血管型，比较差异有统计学意义（P〈0．05）。结论术前TOF—MRA影像学检查可判断面肌痉挛属于椎动脉型或小血管型及镜下手术时间，能预测手术难易程度、手术疗效及颅神经功能障碍发生率，对面肌痉挛的治疗有良好的指导意义．值得推广应用。

Objective To investigate the role of preoperative time of flight magnetic resonance angiography （TOF-MRA） in prognosis of hemifacial spasm after microvascular decompression （MVD）. Methods One hundred and thirty-six patients with hemifacial spasm, admitted to our hospitals from January 2013 to August 2013, were chosen in our study; 44 were vertebral artery type ofhemifacial spasm and 92 were small artery type of hemifacial spasm. These patients accepted MVD operation. Operation time under microscope, operation difficulty degree and post operative recovery degree and rate of cranial neurological dysfunction were retrospectively analyzed between vertebral artery type and small artery type ofhemifacial spasm. Results The preoperative TOF-MRA image features of two types of hemifacial spasm were similar to the intraoperative findings. Operation time under microscope of vertebral artery type was significantly longer than that of small artery type of hemifacial spasm （P〈0.05）. Cure rate of operation and symptomatic relief rate of the two types of hemifacial spasm showed no statistical differences（P〉0.05）. The incidence of cranial neurological dysfunction of vertebral artery type was signficantly higher than that of small artery type （P〈0.05）. Conlusion The preoperative TOF-MRA image features can infer different types of offending vessels and predict surgical difficulty and prognosis.