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。

Vascular compression of cranial nerves studied by MRTA

To study the features of magnetic resonance tomographic angiography (MRTA) in the diagnosis of vascular compression on the cranial nerves. Method: 11 cases of patients with trigeminal neuralgia (TGN) and 21 cases with hemifacial spasm (HFS) were examined by MRTA. Expleratory craniotomy for microvascular decompression were performed in 10 cases. The surgical results were accuratly correlated with the preoperative MRTA findings. Result: Of the unilateral TGX and HFS' s MRTA findings, 28 of 32 cases were confirmed to be the symptomatic side with the vascular compression,except 4 cases. There were only two cases without the images of "vascular compression and touch" in the normal side. In one case of TGN surgery, the petrosal vein was found to have vascular compression. Because it didn' t have gadolinium enhanced imaging after MRTA eventually showed normal. 9 of 10 cases which underwent exploration confirmed fully matched regarding the presence or absense of vascular compression demostrated by MRTA. Conclusion: MRTA is a specific and reliable examination method for preoperatively etiologic diagnosis of vascular compression in cranial nerve disease,and it will guide a suitable treatment for this kind of diseases.