3.0t磁共振斷層血管成像診斷血管壓迫性三叉神經(jīng)痛、面肌痙攣的價值

1、 提 要 目的： 目的：探討 3.0 T 磁共振斷層血管成像(magnetic resonance tomographic angiography, MRTA)對血管壓迫性三叉神經(jīng)痛(trigeminal neuralgia, TN)、面肌痙攣(hemifacial spasm, HFS)診斷的臨床價值。方法： 方法：常規(guī)顱腦磁共振成像(magnetic resonance imaging, MRI)及 MRTA 腦干薄層掃描

2、 16 例 TN 患者和 25 例對照者、36 例HFS 患者和 25 例對照者，利用原始圖像對兩側(cè)三叉神經(jīng)和面神經(jīng)進行斜矢狀位和冠狀位重建，觀測血管神經(jīng)的關(guān)系。由 2 位醫(yī)師盲法評判所見三叉神經(jīng)、面神經(jīng)根部與臨近血管的關(guān)系，并記錄責(zé)任血管的來源及其走行方向。患者組與各自對照組采用SPSS 13.0 軟件包進行卡方檢驗以明確有無統(tǒng)計學(xué)意義。HFS 組中有 5 例行微血管減壓術(shù)(micro-vascular decompression,

3、MVD)。結(jié)果： 結(jié)果：(1)TN 患者癥狀側(cè)面神經(jīng)根部神經(jīng)血管壓迫或接觸 12 例(75%)，可疑接觸 3 例(18.6%)；無癥狀側(cè)神經(jīng)血管壓迫或接觸 1 例(6.3%)，可疑接觸 1 例(6.3%)；對照組雙側(cè)神經(jīng)血管壓迫或接觸 2 例(4%)。HFS 患者痙攣側(cè)面神經(jīng)根部神經(jīng)血管壓迫或接觸 27 例(75%)，可疑接觸 4 例(11.1%)；非痙攣側(cè)神經(jīng)血管壓迫或接觸 2 例(5.6%)， 可疑接觸 2 例(5.6%)； 對照組

4、雙側(cè)神經(jīng)血管壓迫或接觸 3 例(6%)。(2)統(tǒng)計學(xué)分析結(jié)果：三叉神經(jīng)痛患者癥狀側(cè)和無癥狀側(cè)差異有非常顯著性意義(經(jīng) Fisher 確切概率法計算, P＜0.001)；面肌抽搐患者痙攣側(cè)與非痙攣側(cè)差異有非常顯著性意義(χ 2=40.5, P＜0.001)。(3)常見壓迫三叉神經(jīng)的血管為小腦上動脈(superior cerebellar artery, SCA) 13 例(86.7%)，小腦前下動脈(anterior inferior c

5、erebellar artery, AICA) 1 例(6.7%)，起源不清的血管(difficult identified vessels, DIV) 1 例(6.7%)；壓迫面神經(jīng)的血管為 AICA 11例(35.5%)，小腦后下動脈(posterior inferior cerebellar artery, PICA) 9 例(29%)，椎動脈(vertebral artery, VA) 7 例(22.6%)。(4)三叉神經(jīng)根部壓

6、迫側(cè)發(fā)生TN 相對危險度的估計值為 49.74； 面神經(jīng)根部壓迫側(cè)發(fā)生 HFS 相對危險度的估計值為13.71。結(jié)論： 結(jié)論：研究結(jié)果提示，3.0 T MRTA 為目前原發(fā)性 TN、HFS 病因診斷的較好影像檢查方法，原發(fā)性 TN、HFS 的主要病因為患側(cè)三叉神經(jīng)、面神經(jīng)根部受血管壓迫或與其緊密接觸。MRTA 原始圖像及斜矢狀位和冠狀位重建對神經(jīng)血管接觸敏感，能較好地顯示三叉神經(jīng)、面神經(jīng)腦池段與周圍血管之間的關(guān)系，從而為原發(fā)性 TN、H

7、FS的病因診斷及 MVD 術(shù)前評估提供可靠的影像學(xué)依據(jù)。 關(guān)鍵詞 三叉神經(jīng)痛 ；面肌痙攣 ；神經(jīng)血管壓迫(NVC) ；磁共振斷層血管成像(MRTA) (2) The common offending vessels compressing the REZ of the trigeminal nerves were the superior cerebellar artery (SCA) in 13 sides (86.7%), the

8、 anterior inferior cerebellar artery (AICA) in 1 sides (6.7%), and the difficult identified vessels (DIV) in 1 sides (6.7%). The common offending vessels compressing the REZ of the facial nerves were the anterior inferio

9、r cerebellar artery (AICA) in 11 sides (35.5%), the posterior inferior cerebellar artery (PICA) in 9 sides (29%) and the vertebral artery (VA) in 7 sides (22.6%). (3) The relative risks (RR) of microvascular compressions

10、 which caused TN and HFS were 49.74 and 13.71. Conclusion: 3-tesla MRTA appears to be the best imaging technology for the etiological diagnosis of essential trigeminal neuralgia (TN) and hemifacial spasm (HFS) at presen

11、t. The major causes of TN and HFS may be neurovascular compressions or close contacts in the REZ of the trigeminal and facial nerves in symptomatic sides. MRTA original images, oblique sagittal and coronal reconstruction

12、 are sensitive to neurovascular compression, and able to demonstrate the relationship of the cisternal segment of trigeminal and facial nerves with the surrounding vascular structures. They provide reliable imaging evide

13、nce for etiological diagnosis of TN and HFS as well as for clinical preoperative assessment of MVD. Key words trigeminal neuralgia(TN) ; hemifacial spasm(HFS) ; neuro vascular conflict(NVC) ; magnetic resonance tomogr