3D-TOF-MRA联合IONM技术在脑神经血管压迫综合征微血管减压术中的应用探讨

Application of three-dimensional time-of-flight magnetic resonance angiography combined with intraoperative neurophysiological monitoring in microvascular decompression for neu⁃rovascular compression syndrome

目的探讨三维时间飞跃法磁共振血管成像(3D-TOF-MRA)联合术中神经电生理监测(IONM)技术在脑神经血管压迫综合征微血管减压术中的应用价值。方法选取2016年8月-2018年11月该院收治的拟行微血管减压术的218例脑神经血管压迫综合征患者,随机分为研究组与对照组,各109例。两组术前均行3D-TOF-MRA检查,另研究组在术中实施IONM技术。对比手术效果、术后并发症发生情况及术后2年复发率。结果研究组三叉神经痛患者总有效率(100.00%)及面肌痉挛患者总有效率(100.00%)均高于对照组[(90.91%)、(89.19%)](P <0.05),研究组舌咽神经痛患者疗效佳率(100.00%)与对照组(93.75%)比较差异无统计学意义(P>0.05);研究组术后总并发症发生率(4.12%)低于对照组(14.43%),差异有统计学意义(P <0.05);研究组术后2年复发率与对照组比较,差异无统计学意义(P>0.05)。结论在脑神经血管压迫综合征减压术中应用3D-TOF-MRA联合IONM技术,可提高手术效果,减少术后并发症的发生。

Objective To investigate the value of three-dimensional time-of-flight magnetic resonance angiography(3D-TOFMRA)combined with intraoperative neurophysiological monitoring(IONM)in microvascular decompression for neurovascular com⁃pression syndrome.Methods A total of 218 patients with neurovascular compression syndrome who were admitted to our hospital from August 2016 to November 2018 and planned to undergo microvascular decompression were enrolled and randomly divided into study group and control group,with 109 patients in each group.All patients received 3D-TOF-MRA before surgery,and IONM was performed for the patients in the study group during surgery.The two groups were compared in terms of surgical outcome,postoperative complications,and recurrence rate at 2 years after surgery.Results Compared with the control group,the study group had signifi⁃cantly higher overall response rates of patients with trigeminal neuralgia(100.00%vs 90.91%,P<0.05)and patients with hemifacial spasm(100.00%vs 89.19%,P<0.05),and there was no significant difference in the good response rate of patients with glossopharyn⁃geal neuralgia between the study group and the control group(100.00%vs 93.75%,P>0.05).The study group had a significantly low⁃er incidence rate of total postoperative complications than the control group(4.12%vs 14.43%,P<0.05).There was no significant dif⁃ference in recurrence rate at 2 years after surgery between the study group and the control group(P>0.05).Conclusions In micro⁃vascular decompression for neurovascular compression syndrome,3D-TOF-MRA combined with IONM can improve surgical outcome and reduce postoperative complications.