三叉神经-颈反射在Arnold-Chiari畸形中的诊断价值

目的 研究三叉神经-颈反射（TCR）在Chiari畸形中术前临床诊断及术后疗效的评测.方法 2003年12月至2005年1月我院神经内外科门诊和病房收治的经磁共振成像（MRI）确诊的30例ChiariⅠ畸形患者.术前及术后（20～25 d）行TCR检查,观察P19潜伏期、N31潜伏期、A值（取波幅比率的平方根）以及波形.结果 本组30例患者术前TCR异常率为90%（与MRI结果基本吻合）.具体表现为TCR的P19、N31潜伏期延长、A值及两侧差增大、波形消失;术后80%的患者TCR检查P19、N31的潜伏期基本恢复至正常范围,波形消失者波形复现.本组MRI结果为100%的改善.结论 TCR能够比较准确、完整地反映颈延髓区功能,在Chiari畸形的诊断中是除MRI以外可以借鉴使用的一种新型神经电生理检查方法.

The value of trigemino-cervical reflex in the diagnosis of Arnold-Chiari malformation

Objective To study the value of trigemino-cervical reflex (TCR) in the diagnosis of Arnold-Chiari malformation (ACM) and the post-operative evaluation. Methods Thirty patients from the department of neurology and neurosurgery, the Third Hospital, Peking University, who were diagnosed as ACM by head-MRI, underwent neuroelectrophysiological examination for TCR before and after operation. The parameters observed were latency P19, N31 and Value A (the square root of the amplitude), and wave form was also observed. Results Preoperatively, 27 patients (90%) showed abnormal TCR with lengthened latencies of P19, N31, the difference of value A between two sides increased and some waves disappeared. After operation, TCR in 24 patients (80%) showed improved: the latency became normal, and the wave appeared. All patients showed improved head MRI. Conclusions TCR can reveal cervical-bulbar lesion, it is a novel electrophysiological method besides MRI, which can supply objective index in post-operative evaluation of ACM.