三叉神经萎缩对原发性三叉神经痛的诊断价值

Significance of neural atrophy in the diagnosis of primary trigeminal neuralgia

目的探讨三叉神经萎缩在原发性三叉神经痛诊断中的价值。方法回顾性纳入2014年2月至2016年1月青岛大学附属医院神经外科行显微血管减压术（MVD）的59例原发性三叉神经痛（PTN）患者（试验组），以及同期收治的25例面肌痉挛患者（对照组）。测量并比较两组MRI影像上双侧三又神经脑池段的体积和冠状位截面积。探讨责任血管的类型、血管压迫神经的部位、神经受压迫的程度与三叉神经萎缩之间的关系。结果试验组症状侧三又神经的体积[（63．3±14．5）mm2]和冠状位截面积[（3．8±1．1）mm2]均小于非症状侧[分别为（74．4±16．5）mm。和（4．6±1．3）mm2]和对照组[分别为（73．2±13．8）mm。和（4．9±1．1）mm2]（均P〈0．05）。试验组两侧三叉神经体积的差异（AV）[（14．5±3．8）％]和截面积的差异（ACSA）[（11．0±2．8）％]均大于对照组[AV和ACSA分别为（3．7±1．2）％和（2．9±0．7）％]（均P〈0．001）。动脉压迫组[（11．9±4．3）％]与静脉压迫组[（4．8±1．9）％]两侧三又神经ACSA的差异有统计学意义（P=0．016）。Ⅲ＋Ⅱ级压迫组[（12．7±5．1）％]与I级压迫组[（8．4±3．6）％]两侧三叉神经ACSA的差异有统计学意义（P=0．022）。结论三叉神经脑池段的萎缩与PTN发病具有一定的相关性，脑池段三叉神经萎缩可能对PTN具有诊断价值。

[ Abstract] Objective To investigate the significance of atrophy of the trigeminal nerve （cistern portion） in the diagnosis of primary trigeminal neuralgia. Methods We retrospectively analyzed 59 PTN （primary trigeminal neuralgia） patients （experimental group ） and 25 patients with hemifacial spasms （control group） admitted to Department of Neurosurgery, the Affiliated Hospital of Qingdao University from February 2014 to January 2016. The MRI data were used to measure and compare the volumes and CSAs of bilateral trigeminal nerves （cistern portions） in coronal plane. We investigated the relationship of trigeminal nerve atrophy to the type of offending vessels, neurovascular compression regions and extent. Results The mean volume of the trigeminal nerve on the affected side （63.3 ±14.5 mm3 ） was significantly less than that on the eontralateral side （74.4 ±16.5 mm3 ） or in the control group （73.2 ± 13.8 mm3 ） （ all P 〈 0. 05 ）. Similarly, the mean CSA of the trigeminal nerve on the affected side （ 3.8 ± 1. 1 mm2 ） was significantly smaller than that on the contralateral side （4.6 ± 1.3 mm2 ） or in the control group （ 4.9 ± 1.1 mm2 ） （ all P 〈 0.05 ）. The differences of trigeminal nerves in their volumes （ 14.5% ± 3.8 % ） and CSAs （ 11.0% ± 2.8 % ） between the two sides in the PTN group were greater than those in the control group （ volume ： 3.7% ± 1.2% , CSA ： 2.9% ± 0.7% ） （ P 〈 0. 001 ）. Tile CSA difference between the two sides was significantly greater in the arterial compression group （11.9% ± 4. 3% ） than venous compression group （4.8% - 1.9% ） （P =0. 016）, and greater in the degree III and II compression groups than degree I compression group （P = 0. 022 ）. Conclusion Trigeminal nerve （cistern portion） atrophy might be associated with PTN and have certain value for the diagnosis of PTN.