MRI成像和微血管减压术对原发性三叉神经痛责任血管的分析报告

目的 对照分析三叉神经痛的磁共振断层血管成像(MRTA)不同成像序列表现并结合微血管减压术中所见,明确导致三叉神经痛的“责任血管”.方法 回顾128例经临床诊断为原发性三又神经痛并行微血管减压术(MVD)患者的临床资料;全部行MRTA检查,采用3D— TOF、B— TFE、THRIVE及MIP序列扫描,对病变侧三叉神经进行轴位、矢状位、冠状位重建,观察血管神经走行关系,并与MVD所见进行比较分析,判断责任血管.结果 本组128例患者,分别根据MRTA的B — TFE、3D —TOF、THRIVE及MIP 4个重建断面融合图像分析患侧三又神经和责任血管存在接触或压迫,其中小脑上动脉55例(43％);小脑前下动脉38例(30％);椎、基底动脉26例(20％);岩静脉9例(7％).阳性率达90％.与术中所见有较高的一致性.结论 导致三叉神经痛的“责任血管”主要为小脑上动脉,其次是小脑前下动脉,椎、基底动脉和岩静脉.选择MRTA的3D — TOF、B— TFE、THRIVE及MIP序列扫描可以显示责任血管,并具有较高的阳性结果.     

三叉神经痛术前磁共振断层血管成像结果与微血管减压手术疗效的对比研究

目的 探讨三叉神经痛术前磁共振断层血管成像(magnetic resonance tomographil angiography,MRTA)结果与微血管减压(microvascular decompression,MVD)手术疗效的关系.方法 回顾性分析167例三叉神经痛MVD术前MRTA影像学检查资料,结合手术所见压迫血管的类型,对比分析MRTA中有无责任血管与手术预后的关系.患者术后获6个月～6年随访,平均3.5年.随访结果按优、良、差进行分类.结果 144例术前MRTA阳性患者的预后明显好于23例术前MRTA阴性的患者(P＜0.01).术中为单一动脉压迫患者的预后明显好于有静脉参与压迫或未发现责任血管压迫的患者(P＜0.01).术前MRTA阴性且预后差的7例中,4例为单纯静脉压迫,3例神经根周围未见责任血管而仅有蛛网膜增厚粘连.结论 非动脉压迫因素是三叉神经痛预后不良的重要因素之一.MRTA有助于术前判断MVD手术的预后,为术前筛选手术病人提供有效的方法.     

神经内镜辅助显微血管减压术治疗MRTA阴性原发性三叉神经痛的疗效

目的 探讨神经内镜辅助显微血管减压术（MVD）治疗磁共振断层血管成像（MRTA）阴性原发性三叉神经痛的疗效。方法 回顾性分析2017年1月至2020年5月运用神经内镜辅助MVD治疗的27例MRTA阴性原发性三叉神经痛的临床资料。结果 27例中,术中显微镜下可确认责任血管19例,神经内镜确认责任血管6例,全程探查三叉神经脑池段后未见明确责任血管2例。25例可明确责任血管中,9例责任血管为动脉,15例责任血管为静脉,1例为动静脉同时压迫。显微镜难以观察责任动脉时,神经内镜可以清楚显示三叉神经根部解剖情况,明确责任动脉。术后疼痛完全缓解23例,明显缓解3例,部分缓解1例。随访4~43个月,27例症状无加重或复发。3例术后出现面部麻木,经营养神经等治疗后缓解。结论 神经内镜可提供更多的观察角度,辅助MVD治疗MRTA阴性原发性三叉神经痛的效果良好。     

3D-TOF-MRA成像对微血管减压术术前诊断的价值

目的观察三维时间飞越法磁共振血管成像(3D-TOF-MRA)结合MR重建技术对微血管减压手术(MVD)的价值。方法对11例三叉神经痛,17例面肌痉挛,1例复发性舌咽神经痛,1例三叉神经痛合并面肌痉挛患者采用MVD治疗。术前应用3D-TOF-MRA结合MR重建技术进行检查,寻找和判别责任血管,以指导临床手术。结果术前3D-TOF-MRA检查30例中,28例证实有明显的责任血管,并在术中得到证实;2例三叉神经痛患者3D-TOF-MRA检查、未发现责任血管,其中1例术中发现为三叉神经出脑干区腹侧受到基底动脉明显压迫,另外1例术中可见小脑上动脉有多支细小动脉攀附于三叉神经出脑干区,给予MVD+选择性三叉神经感觉根切断术后症状完全缓解。30例患者中,术后完全缓解26例,明显缓解4例。结论 3D-TOF-MRA结合MR重建技术对于微血管减压术术前责任血管的判定及手术设计具有重要的应用价值。     

原发性三叉神经痛特征性MRI序列检查的临床应用

目的探讨磁共振断层血管成像(MRTA)不同成像序列在诊断三叉神经痛血管神经压迫的价值。方法回顾分析128例原发性三叉神经痛病人的临床资料,全部行微血管减压术(MVD)。术前均行MRTA检查,运用三维时间飞跃成像序列(3D-TOF)、超快平衡场回波序列(B-TFE)、T1高分辨率各向同性容积激发序列(THRIVE)及最大密度投影法(MIP)重建,观察血管神经走行关系,并与术中所见进行对比。结果 MRTA检查共发现责任血管115例,三叉神经无血管压迫13例;术中观察发现责任血管122例,三叉神经无血管压迫6例。MRTA检查与术中观察情况一致121例(95%)。本组治愈106例,显效15例,有效5例,无效2例。结论 MRTA检查对发现原发性三叉神经痛的责任血管与神经关系具有重要价值,3D-TOF、B-TFE、THRIVE及MIP序列扫描可显示责任血管,并具有较高的准确性,对术前评估和指导手术具有重要意义。     

微血管减压术治疗原发性三叉神经痛

目的综合评价三叉神经微血管减压术治疗原发性三叉神经痛的近远期疗效及手术风险。方法回顾性分析三叉神经微血管减压术治疗的原发性三叉神经痛25例患者临床资料。手术采用乙状窦后入路,术中分离血管神经后用Teflon补片分隔。结果术中发现24例有血管压迫,18例为小脑上动脉压迫,1例为基底动脉,3例为小脑前下动脉,1例为岩静脉压迫,1例为小脑上动脉和岩静脉压迫,另1例未发现血管压迫。结论三叉神经显微血管减压术临床适应证广泛,对神经损伤小,临床疗效满意,但手术风险不容忽视。     

微血管减压术治疗原发性三叉神经痛126例

目的探讨微血管减压术(MVD)治疗原发性三叉神经痛(PTN)的临床疗效。方法回顾性分析采用经乙状窦后入路MVD治疗的126例PTN的临床资料。结果责任血管为单支血管105例,多支血管19例,蛛网膜增厚粘连2例;单纯动脉压迫111例,其中小脑上动脉49例;压迫部位于三叉神经根部98例;三维时间飞跃法核磁共振血管成像(3D-TOF MRA)阳性检出率为88.9%。107例术后随访6~96个月,平均50个月;失访19例。术后6个月治愈96例,显著有效5例,有效5例,无效1例;复发3例,遗留并发症8例。结论 PTN责任血管压迫形式多种多样,但是以单发动脉性压迫神经根部为主;术前3D-TOF MRA检查可基本明确三叉神经与毗邻血管的关系;MVD对PTN治愈率高、复发率低,能获得满意的临床治疗效果。     

微血管减压术治疗三叉神经痛的病因学研究(附84例临床分析)

目的将三叉神经痛微血管减压术结果与术前磁共振血管成像对比研究,探索术前确定三叉神经痛病因的方法。方法利用MRI三维时间飞跃破坏性梯度回聚回波序列对84例三叉神经痛病人行颅脑扫描,观察三叉神经的走形与邻近血管的关系,其中68例行手术治疗。结果MRI显示患侧三叉神经与血管密切接触79例,手术治疗68例与MRI扫描62例阳性相符,2例为岩静脉压迫并蛛网膜粘连。结论血管压迫是三叉神经痛的主要病因,微血管减压术可取得良好效果,磁共振血管成像有益于三叉神经痛的术前病因诊断。     

三叉神经痛微血管减压术中对非单纯动脉压迫因素处理的临床分析

目的 探讨三叉神经痛(TN)微血管减压(MVD)术中对非单纯动脉压迫因素的处理方式及其临床疗效.方法 回顾性分析69例非单纯动脉压迫致三叉神经痛行MVD术患者的临床资料.其中责任血管为小脑上/前下动脉及其分支合并岩静脉压迫的患者34例,单纯静脉压迫患者17例,椎-基底动脉扩张延长症合并分支血管压迫患者10例,无责任血管...     

脑神经疾患“血管压迫”病因的放射学诊断研究——磁共振断层成像脑血管造影术的应用

目的:探讨磁共振影像学对“压迫血管”病因诊断的可能性和特征。方法:采用稳定快速进动程序以提供脑实质、脑神经和后颅窝脑血管的高分辨率磁共振成像(MRI),即一种“白血”磁共振断层成像血管显影术(magnetic resonance tomographic angiography,MRTA)。分别检查11例三叉神经痛和21例面肌痉挛,同时10例行后颅窝探查及显微血管减压术(microvascular decompression,MVD),对照和评估MRTA的确诊率。结果:32例单侧三叉神经痛及面肌痉挛的MRTA中,确认患侧有“血管压迫”28例,无血管压迫4例。而正常侧仅见2例“血管接触或压迫”影像。1例三叉神经痛术中发现岩静脉为压迫血管,而MRTA提示无异常,因而未再行增强扫描、10例接受探查术发现有或无压迫血管,与MRTA诊断相符9例。结论:MRTA可作为脑神经疾患的”血管压迫”病因之术前诊断的一种特殊而可靠的检查方法,以便有的放矢地指导此类疾患的治疗。     

三叉神经痛微血管减压术中责任血管与磁共振影像的相关性

目的探讨三叉神经痛责任血管微血管减压术前磁共振成像和术中所见血管神经的相关性。方法回顾95例三叉神经微血管减压手术病例术前磁共振成像（3D-CISS、3D-TOF-MRA、3D-T₁增强）资料和手术录像,分析三叉神经痛的责任血管的来源、走行和压迫神经根的形式在微血管减压手术所见与术前磁共振成像关系。结果 86例术前MRI显示神经与血管关系密切,术中均证实。9例术前MRI显示神经与血管关系不密切者,6例术中证实责任血管存在,3例未发现责任血管。手术有效率95.7%（91/95）。结论责任血管在微血管减压术中所见与术前磁共振多序列成像结果有高度的相关性。     

Microvascular decompression for recurrent trigeminal neuralgia

Recurrence of trigeminal neuralgia (TN) symptoms after microvascular decompression (MVD) is a challenge for neurosurgeons. This study evaluates the indication, efficacy and safety of re-do MVD. We retrospectively reviewed consecutive patients who underwent MVD for TN from January 2000 to June 2012. The parameters of study interest were pre-operative magnetic resonance tomographic angiography (MRTA) findings and operative findings. Pain outcome was scored using the Barrow Neurological Institute (BNI) grading scale. Twelve patients underwent re-do MVD following recurrence of pain. Vascular compression was detected on pre-operative MRTA images in eight patients, a small mass was found in two patients, and pre-operative imaging was negative in two patients. Of the eight patients with a positive finding of arterial conflict, a vascular loop was identified intra-operatively in five patients (62.5%); in two (25.0%) a small granuloma filled with Teflon fibers was found compressed the trigeminal nerve; and in one patient (12.5%) only dense arachnoid adhesions were found around the trigeminal nerve. For the two patients with mass compression on MRTA images, a granuloma was found during operation. Neurovascular compression was found in the two patients with negative preoperative MRTA images. Re-do MVD is a safe and effective treatment for recurrent TN when indicated by a prolonged pain-free period following the first surgery.     

原发性三叉神经痛微血管减压术后复发的相关因素分析

目的 探讨原发性三叉神经痛病人经微血管减压术(microvascular decompression,MVD)治疗后复发的危险因素.方法 回顾性分析261例经MVD手术的原发性三叉神经痛病人的临床资料.行单因素卡方检验和Logistic多因素回归分析术后复发的独立危险因素.结果 本组原发性三叉神经痛总复发率为14.9％...     

磁共振断层血管成像及神经内镜在判断原发性三叉神经痛病因中的作用

目的 探讨磁共振断层血管成像(MRTA)及神经内镜在判断原发性三叉神经痛病因中所起的作用. 方法 回顾性分析行微血管减压术治疗的49例原发性三叉神经痛患者的临床资料、影像学资料及手术资料.所有患者术前均行MRTA检查,术中垫入隔片前置入30°神经内镜行多角度观察. 结果 本组患者MRTA阳性率为77.6%(38/49),MRTA检测为阳性者在术中均得到证实,无一例假阳性.4例术中无法判别可疑血管是否为责任血管者应用神经内镜予以了明确.49例患者中术后47例(95.9%)疼痛消失,1例(2.0%)疼痛减轻,总有效率为97.9%. 结论 MRTA及神经内镜技术有助于判断原发性三叉神经痛的病因,提高手术的安全性和有效性.

Abstract：

Objective To explore the role of magnetic resonance tomographic angiography (MRTA) and neuroendoscope in determining the etiology of idiopathic trigeminal neuralgia. Methods Forty-nine patients with idiopathic trigeminal neuralgia, performed microvascular decompression were chosen; their clinical data, imaging data and operative data were retrospectively analyzed. All patients underwent preoperative MRTA; and before placing intraoperative Teflon, 30° neuroendoscope was applied for multi-angle exploration. Results Positive rate reached 77.6% under MRTA. All patients with positive results under MRTA were confirmed, without a false-positive. Neuroendoscope helped to determine whether the suspect vessels were the offending vessels in 4 patients. The total effective rate in 49 patients was 97.9%; pain disappeared in 47 patients (95.9%) and pain relieved in 1 (2.0%).Conclusion MRTA and neuroendoscope can help to determine the etiology of idiopathic trigeminal neuralgia, and improve the safety and effectiveness of MVD.     

微血管减压术治疗脑神经血管压迫综合征

目的 总结和分析微血管减压术(MVD)治疗脑神经血管压迫综合征的疗效与术后并发症. 方法 应用MVD治疗脑神经血管压迫综合征39例(三又神经痛19例,面肌痉挛18例,舌咽神经痛2例)并探讨手术技巧及术后并发症的防治.结果 2例舌咽神经痛患者和17例三叉神经痛患者术后疼痛立即消失,面肌痉挛患者中有16例术后痉挛立即消失.术后无血肿、感染、脑脊液漏、偏瘫和死亡病例.34例获随访,平均随访1.58年,其中32例效果良好. 结论 MVD治疗脑神经血管压迫综合征安全、微创、有效,是目前治疗脑神经血管压迫综合征的首选方法.     

提高颅神经显微血管减压术疗效的临床研究(附1950例报告)

目的探讨微血管减压术治疗三叉神经痛、面肌痉挛、舌咽神经痛方法的改进措施和提高治疗效果的临床经验.方法自1984年12月至2004年6月采用微血管减压术治疗1950例颅神经血管压迫综合征病例,其中三叉神经痛1 515例,面肌痉挛400例,舌咽神经痛35例.结果全部病例术中均发现有明确的压迫血管,总有效1 886例,有效率为96.7%,无死亡病例.由于显微外科技术的应用及手术技巧的提高,并发症发生率由8年前的10.55%下降到近8年的2.88%.结论显微血管减压术是三叉神经痛、面肌痉挛和舌咽神经痛最有效的治疗方法.术中颅神经根部的显露、责任血管的识别及减压材料的放置等是影响手术效果的关键.提高微血管减压术的治愈率、减少并发症及复发率有多方面因素值得考虑.     

磁共振体层成像脑血管显影术(MRTA)对颅神经疾患“血管压迫”病因的诊断

采用磁共振体层成像血管显像术(MRTA)检查11例三叉神经痛和21例面肌痉挛,其中10例行后颅窝探查.32例MRTA检查中,确认患侧有“血管压迫”28例,无血管压迫4例.10例接受探查术发现有或无压迫血管,与MRTA诊断相符9例.1例岩静脉压迫因未行增强扫描而漏诊.MRTA可作为此类疾患“血管压迫”的术前病因诊断方法.     

Etiologic exploration of magnetic resonance tomographic angiography negative trigeminal neuralgia

Our objective was to explore the etiologic factors involved in trigeminal neuralgia with negative magnetic resonance tomographic angiography (MRTA) results. Clinical data from 341 patients with idiopathic trigeminal neuralgia who were treated with neurovascular decompression between March 2003 and December 2011 were retrospectively analyzed. The etiologic causes of preoperative MRTA-negative trigeminal neuralgia were categorized based on comparisons between preoperative MRTA and intraoperative endoscopic images. MRTA was highly sensitive (92.4%, 291/315) to neurovascular compression, whereas its specificity was 65.4% (17/26). Among the 24 false-negative cases, there were nine patients with petrosal vein compression, 12 with superior cerebellar artery compression, two with superior cerebellar arterial branch compression, and one patient with anterior inferior cerebellar artery compression. Among the 17 true-negative cases, three patients had arachnoid adhesions, one had a protruding temporal eminence, five had micro-cholesteatomas, and eight patients exhibited no compression. The factors responsible for the MRTA-negative results included small-diameter arterial vessels, veins with slow blood flow, arachnoid adhesions, protruding temporal eminences, micro-cholesteatomas, and other pathologies such as multiple sclerosis. Preoperative diagnoses of MRTA-negative patients need to integrate the MRI results from multiple sequences to discriminate between arteriolar compression, venous compression, and small compressive lesions. When narrow cerebellopontine angles are shown in MRTA, arachnoid adhesion and temporal eminence compression should be considered.     

The significance of three-dimensional MR-defined neurovascular compression for the pathogenesis of trigeminal neuralgia

Three-dimensional MR tomography was used to examine the relationship between symptoms of trigeminal neuralgia and neurovascular compression of the nerve in 18 patients. The intensity of neurovascular interaction was classified according to neuroradiological criteria. We found that a radiologically defined compression or dislocation of the nerve by an artery was always associated with symptoms of trigeminal neuralgia. A simple contanct between vessel and nerve, however, was also observed on the asymptomatic sides of 10 out of 18 patients. In 6 of 18 patients, in contrast, trigeminal neuralgia was present in spite of the absence of neurovascular contact. In accordance with a cited study based on autopsy and intraoperative findings, our findings indicate that, in a certain proportion of cases, trigeminal neuralgia may be caused by neurovascular compression alone, whereas in other cases, other pathogenetic factors may be involved to a varying degree or be even exclusively responsible for the development of trigeminal neuralgia. The possible significance of the method for a preoperative estimation of the success of microvascular decompression of the trigeminal nerve is discussed.