原发性三叉神经痛术前MRI特征与疼痛程度及射频热凝术预后的关系

Study on the correlation of idiopathic trigeminal neuralgia MRI morphology with pain degree and prognosis of percutanous radiofrequency thermocoagulation

目的:回顾性分析95例原发性三叉神经痛(idiopathic trigeminal neuralgia,ITN)病人的三叉神经MRI形态学特征,探讨其与疼痛程度以及经皮穿刺射频热凝术(percutaneous radiofrequency thermocoagulation,PRT)预后的相关性。方法:收集经PRT治疗的95例单侧ITN病人的一般资料及MRI影像。测量并比较其MRI形态学指标包括双侧三叉神经根(trigeminal nerve root,TR)长度及截面积、神经脑桥夹角、神经跨岩尖转角、血管神经位置关系,计算三叉神经萎缩程度。评估三叉神经MRI形态学特征与NRS评分的相关性。通过电话随访获取病人PRT术后疗效信息并分为复发组和未复发组,采用单因素和Logistic多因素回归分析评价影响PRT预后的独立危险因素。结果:ITN病人症状侧三叉神经根截面积、神经脑桥夹角小于非症状侧(P<0.05);神经脑桥夹角与NRS评分呈负相关(r=-0.206,P<0.05);单因素统计分析显示:病人病程、TR长度和萎缩程度与PRT的预后有关(P<0.05);进一步行Logistic多因素回归分析显示:病程是影响PRT术后复发的独立危险因素(OR=2.834,P<0.05)。结论:症状侧三叉神经萎缩以及较小的神经脑桥夹角对ITN的诊断具有一定的参考价值;神经脑桥夹角与病人的疼痛程度有关;病程的长短是影响PRT预后的独立危险因素。

Objective:To retrospectively analyze the morphology factors of trigeminal nerve in 95 patients with idiopathic trigeminal neuralgia(ITN),and to explore its correlation with pain degree and the prognosis of percutaneous radiofrequency thermocoagulation(PRT).Methods:The general data and MRI images of 95 patients with unilateral ITN treated by PRT were collected.The MRI morphological indexes including the length and cross-sectional area of trigeminal nerve root,trigeminal-pontine angle,angle of trigeminal nerve root across petrous apex on both sides,and neurovascular relationship were measured and compared.The atrophy degree of trigeminal nerve root was calculated.The correlation between MRI morphology of trigeminal nerve and NRS score was evaluated.The postoperative efficacy of PRT was obtained through telephone follow-up and the patients were divided into recurrence group and non-recurrence group.Univariate and Logistic multivariate regression analyces were used to evaluate the independent risk factors affecting the prognosis of PRT.Results:The trigeminal root cross-sectional area and trigeminal-pontine angle on the symptomatic side of ITN patients were smaller than those on the asymptomatic side(P<0.05).The trigeminal-pontine angle was negatively correlated with NRS score(r=-0.206,P<0.05).Univariate analysis showed that the course of disease,the TR length and the atrophy degree were related to the prognosis of PRT(P<0.05),and logistic regression analysis showed that the course of disease was an independent risk factor for recurrence after PRT(OR=2.834,P<0.05).Conclusions:The symptomatic side trigeminal nerve atrophy and the small trigeminal-pontine angle have reference value for the diagnosis of ITN.The trigeminal-pontine angle is related to pain degree and the course of disease is an independent risk factor for the prognosis of PRT.