磁共振断层血管造影在三叉神经微血管减压术术前评估中的应用价值

目的探讨磁共振断层血管成像(MRTA)对三叉神经微血管减压术术前评估的应用价值。方法回顾性分析我科自2006年1月到2010年12月对211例原发性三叉神经痛行三叉神经微血管减压术(MVD)的病例资料。将术前MRTA检查情况与术中探查结果进行对比研究。结果 211例患者MRTA显示:症状侧三叉神经血管压迫(neurovascular compression,NVC)阳性194例,阳性率达91.9%,MVD术发现血管神经压迫201例,阳性率达95.3%:其中小脑上动脉82例(38.9%),小脑前下动脉41例(19.4%),基底动脉18例(8.5%),小脑后下动脉7例(3.3%),复合压迫42例(19.9%),静脉11例(5.2%)。MRTA显示无血管压迫17例,阴性率8.1%,而术中发现无责任血管10例,阴性符合率58.8%。症状对侧血管压迫阳性38例,假阳性率18%。结论 MRTA是三叉神经痛术前评估的有效方法,阳性率高,排除器质性改变致继发性可能外,可清楚显示血管压迫的存在、来源及走向,使术者心中有数。

Application of magnetic resonance tomographic angiography to preoperative evaluation in microvascular decompression for trigeminal neuralgia

Objective To investigate the value of magnetic resonance tomographic angiography(MRTA) for preoperative assessment in microvascular decompression for trigeminal neuralgia.Methods 211 cases of primary trigeminal neuralgia underwent microvascular decompression(MVD) from January 2006 to December 2010 were retrospective analysised,the MRTA preoperative and the intraoperative exploration results were compared.Results MRTA identified surgically verified neurovascular compression in 194 of 211(91.9%) symptomatic nerves.Neurovascular compression was observed in 38 of 211(18%) of asymptomatic nerves.201 cases(95.3%) which neurovascular compression(NVC) were observed during operation underwent MVD: 82 cases(38.9%) with SCA,41 cases(19.4%) with AICA,7 cases(3.3%) with PICA,18 caces with BA(8.5%),42 cases(19.9%) with compounding compression,11 cases(5.2%) with vein.NVC was’t identified in 17 cases(8.1%),of which NVC 10 cases(58.8%) weren’t observed during operation underwent trigeminal rhizotomy.Conclusion MRTA is a sensitive diagnostic tool with positive predictive value of neurovascular compression in the trigeminal neuralgia population,its can demonstrate the details of neurovascular compression sensitively.