后颅窝空间大小与面肌痉挛发生的相关性

摘要

Objective To quantitatively study the posterior fossa effective space and its relationship with hemifacial spasm (HFS).Methods We conducted a case-control study of patients diagnosed with HFS and sex-and age-matched healthy controls.All subjects underwent high-resolution three-dimensional MRI.The software of 3D-Slicer was used to measure the posterior fossa space and hindbrain tissue volume between the two groups.Results Sixty patients and 60 controls were enrolled in this study.Compared to controls,patients with HFS had a higher posterior fossa crowdedness index (PFCI;83.7％ ± 0.6％ vs 79.2％ ± 0.4％;t =2.58, P =0.01).The multivariate linear regression analysis revealed that a higher PFCI was associated with younger age (r =-0.61, P =0.02), female gender (r =0.76, P =0.003) and HFS (r =-0.43, P =0.01).Conclusions Patients with HFS have a more crowded posterior fossa space than healthy controls, potentially leading to cranial nerve and vascular structure crowding, thus increasing HFS risk.Women have a higher PFCI, which may explain the strong female preponderance in epidemiologic studies.%目的 定量研究面肌痉挛患者及健康人后颅窝有效空间大小,探索后颅窝容积缩小与面肌痉挛发生之间的相关性.方法 共纳入2013年5月至2014年6月就诊于四川大学华西医院神经外科的60例诊断明确的面肌痉挛患者,60名对照为性别、年龄配对的健康人.两组均行头部三维薄层磁共振检查,利用容积测量软件3 D-slicer分别测量两组后颅窝脑组织和骨性空间大小.结果 面肌痉挛患者组后颅窝拥挤指数为83.7％±0.6％;健康对照组后颅窝拥挤指数为79.2％±0.4％,两组差异有统计学意义(t=2.58,P=0.01).多元线性回归分析提示较高的后颅窝拥挤指数与较小的年龄(r=-0.61,P=0.02)、女性(r=0.76,P=0.003)及面肌痉挛患者(r=-0.43,P=0.01)相关.结论 面肌痉挛患者后颅窝较健康对照组更加拥挤,后颅窝空间狭小可能与"神经血管冲突"的发生相关,进而更容易导致面肌痉挛.女性较男性的后颅窝更加拥挤,这可能部分解释了面肌痉挛中女性高发的原因.