面肌痉挛3D-TOF-MRA与手术结果对比性研究

目的探讨术前三维时间飞越法磁共振血管成像（3D—TOF—MRA）对面肌痉挛的诊断及手术指导价值。方法总结分析51例面肌痉挛病人术前3D—TOF—MRA图像，利用原始图像对两侧面神经斜矢状位和冠状位、横断面进行重建，观察血管与面神经近脑干端的关系，特别是有无血管跨越及推挤面神经，判明责任血管，并与术中发现进行对比。结果3D—TOF—MRA显示面神经102侧；症状侧血管接触或压迫面神经45例，接近2例，远离3例，无血管1例；症状侧与无症状侧比较．血管接触与压迫情况差异有统计学意义。3D—TOF—MRA诊断面肌痉挛敏感度88．2％；与手术结果比较，准确度为91．8％。结论3D—TOF—MRA能清晰显示面神经脑池段及其与毗邻血管的关系，对责任血管的诊断有较高的敏感度和准确度，是面肌痉挛术前病因评估的重要指标，对指导术者探察责任血管，避免遗漏，提高手术疗效等方面具有重要意义。

Comparative study of 3D-TOF-MRA and operative results in hemifacial spasm

Objective To evaluate the clinical significance of preoperative 3 dimensional time of flight magnetic resonance angiography (3D-TOF-MRA) in diagnosis and guidance of operation for hemifacial spasm (HFS). Methods Preoperative 3D-TOF-MRA angiograph of 51 cases with HFS was summarized. The oblique sagittal, coronal, and cross sections of the bilateral facial nerves were reconstructed based on the original images for observing the relation of the vessels to the fragment of the facial nerve close to the brain stem, especially whether there was vascular cross and compression of the facial nerve and judging the responsible vessels, which were compared with the surgery findings. Results 3D-TOF-MRA angiography showed the facial nerve in all of the 102 sides. At the symptom side, there was vascular compression or contacting with the facial nerve in 45 cases, the vessel close to the facial nerve in 2, the vessel away from the nerve in 3, and no vascular in 1. The difference in vascular contact and compression between the symptomatic sides and asymptomatic sides was statistically significant. The sensitivity of 3D-TOF-MRA for diagnosing vascular compression or contact was 88.2%, and the accuracy compared with the surgery was 91.8%. Conclusion 3D-TOF-MRA plays an important role in demonstrating the relationship of the cisternal portion of facial nerve with its surrounding vasculature, and has high sensitivity and accuracy in judging neurovascular compression or contact, which may help to select the proper method for treating patients with HFS. 3D-TOF-MRA appears to be an important imaging test for determining pathogenesis of HFS.