磁共振断层血管成像仪在三叉神经痛微血管减压术中的应用研究

Evaluation of magnetic resonance tomographic angiography in microvaslular decompression for trigeminal neuralgia

目的检验磁共振断层血管成像(MRTA)对判断血管神经压迫(NVC)程度的准确性,评价其对微血管减压(MVD)手术适应证判断的指导价值。方法对322例原发性三叉神经痛的患者行MVD。根据患者术前MRTA表现对NVC分级,并与术中NVC对比,采用Kappa(SPSS14.0)检验术前MRTA与术中NVC的一致度。根据术后随访情况将疗效分级,并分析术前不同NVC分级的患者术后疗效的差异。结果 322例患者术前MRTA提示的NVC情况与术中表现无明显差异(χ~2=6.182,P=0.103】0.05),两者具有较高一致度(Kappa=0.811)。术后随访,277例患者(86.0%)术后疗效为优,27例患者(8.4%)为良,18例(5.6%)为差。术前NVC 0-1级的患者MVD有效率(疗效为优)81.8%(95/116),术后NVC 2-3级的患者有效率为88.3%(182/206)。结论术前MRTA提示神经受压较为严重的患者(NVC 2级和3级)MVD术后获得较好疗效,为MVD的明确手术指征。

Objective To evaluate the accuracy of magnetic resonance tomographic angiography(MRTA) on determining the degree of vascular nerve compression(NVC),as well as the value to indicate microvascular decompression (MVD).Methods 322 patients with primary trigeminal neuralgia(TN) came to the outpatient clinic from 2003 to 2011 were enrolled in the study and treated with MVD.The degree of NVC was graded according to MRTA finding before surgery,and were compared with that of NVC found in surgery.The consistency of the NVC s degrees was statistically verified with Kappa test provided by SPSS 14.0 software.The surgical outcomes were graded according to the follow-up and were analyzed among patients of different NVC grades.Results No significant difference was found between the NVC degrees defined by presurgery MRTA and surgery findings(χ~2=6.182,P =0.103 >0.05),and these two NVC degrees were highly consistent(kappa=0.811).Following MVD,277 cases(86.0%) graded excellent,27 cases(8.4%)graded good and 18 cases(5.6%)graded poor.The success rate was 81.8%(95 out of 116)for grade 0-1 NVC and 88.3%(182 out of 206) for grade 2-3.NVC.Conclusions The patients with severe NVC(grade 2-3 according to presurgery MRTA) were recommended to receive MVD.