磁共振断层血管成像在三叉神经痛手术治疗及其病因学研究中的作用

目的探讨磁共振断层血管成像在指导三叉神经痛手术治疗及其病因学研究中的作用。方法对84例三叉神经痛患者行颅脑MRI扫描并使用三维时间飞跃破坏性梯度回聚回波序列观察三叉神经的走行与邻近血管的关系。对其中68例行手术治疗。观察MRI结果与术中所见一致程度，并观察三叉神经痛与局部血管压迫的关系。结果MRI显示患侧血管与三叉神经接触79例．健侧12例。手术治疗的68例中MRI扫描62例阳性与手术相符，4例为较细小动脉压迫三叉神经．2例为岩静脉压迫并与蛛网膜粘连。结论三叉神经人根区血管压迫是三叉神经痛发病的主要原因，磁共振断层血管成像能够确定三叉神经痛患者的血管与神经关系，有益于三叉神经痛的病因诊断和指导手术治疗。

The role of three-dimensional reconstruction with high-resolution magnetic resonance tomographic angiography in microyascular decompression and etiological study of trigeminal neuralgia

Objective To analyze the role of high-resolution magnetic resonance tomographic angiography(MRTA)in microvascular decompression(MVD)and etiological study of trigeminal neuralgia(TN). Methods Craniocerebral MRI was performed in 84 cases with TN and three-dimensional time-of-flight(3D-TOF)MR angiography(MRA)using spoiled gradient-recalled-echo sequences was applied to observe the course of the trigeminal nerve and its relation to adjacent blood vessels. Among these cases, 68 underwent surgical treatment. MRI findings and intraoperative manifestations were analyzed comparatively and the correlation between TN and local vascular compression was also observed. Results MRI showed that the affected side blood vessels of 79 cases touched the trigeminal nerve and the intact side vessels of 12 cases touched the trigeminal nerve.Among the 68 cases undergoing MVD,62 had surgical results entirely consistent with MRI findings,4 had their relatively fine arteries oppressing the trigeminal nerve and 2 had petrosal vein compression combined with arachnoid adhesion. Conclusion Vascular compression at the root entry zone(REZ) of the trigeminal nerve is the one of the primary causes of TN.The technique of 3D-TOF MRA may determine the correlation between blood vessels and nerves in patients with TN,which is helpful for the diagnosis of etiological factors for TN and benefits MVD.