三叉神经痛及面肌痉挛患者神经血管压迫的术前 MRI 表现与手术结果对照研究

摘要

目的：探讨磁共振（magnetic resonance imaging，MRI）三维快速平衡稳态进动成像序列对三叉神经痛（tri-geminal neuralgia，TN）及面肌痉挛（hemifacial spasm，HFS）患者神经与血管压迫的诊断价值及手术指导价值。方法回顾性分析20例 TN 及24例 HFS 患者的临床资料及术前 MRI 表现，了解主要责任血管及 MRI 三维快速平衡稳态进动成像序列对神经与血管关系的显示能力。结果20例 TN 患者经手术证实神经受动脉压迫17例，神经受静脉压迫3例。三维快速平衡稳态进动成像序列显示压迫15例，可疑接触2例，阴性3例。24例 HFS 患者经手术证实神经受动脉压迫22例，静脉压迫2例。三维快速平衡稳态进动成像序列显示压迫16例，可疑接触 4例，阴性 4例。三维快速平衡稳态进动成像序列显示 TN、HFS 压迫及可疑接触的阳性率分别为85．0％（17／20）、83．3％（20／24）。结论TN 及 HFS 的主要责任血管分别为小脑上动脉和小脑前下动脉。三维快速平衡稳态进动成像序列能够清晰显示三叉神经及面听神经与邻近血管之间的关系，对神经与血管压迫或可疑接触的诊断有较高的价值，能够在临床术前评估和指导治疗上发挥重要的作用。%ABSTRACT:Objective To evaluate the value of three-dimensional fast imaging employing stead-y-state acquisition(3D-FIESTA)MRI sequence in the diagnosis of neurovascular compression and operation guidance in patients with trigeminal neuralgia(TN)or hemifacial spasm(HFS).Methods Clinical data and preoperative MRI manifestations of 20 TN patients and 24 HFS patients were retrospectively analyzed to understand the main responsible blood vessels and the ability of 3D-FI-ESTA MRI sequence to display the relationship between nerves and vessels.Results Among the 20 patients with TN,arterial compression of trigeminal nerve was confirmed by operation in 17, and venous compression of trigeminal nerve in 3.Furthermore,3D-FIESTA sequence showed compression in 15 patients,suspected contact in 2 patients,and no contact 3 patients.Among the 24 patients with HFS,arterial compression of trigeminal nerve was confirmed by operation in 22, and venous compression of trigeminal nerve in 2.Moreover,3D-FIESTA sequence showed com-pression in 16 patients,suspected contact in 4 patients,and no contact 4 patients.The positive rates of compression and suspected contact diagnosed by 3D-FIESTA sequence was 85.0%(17/20)in TN patients,and 83.3%(20/24)in HFS patients.Conclusion The primary responsible vessels of TN and HFS are the superior cerebellar artery and anterior inferior cerebellar artery, respectively.The 3D-FIESTA sequence can clearly display the relationship between trigeminal/fa-cial nerve and adjacent blood vessels.Therefore,3D-FIESTA sequence has a higher value in the diagnosis of neurovascular compression or suspected contact,and plays an important role in preop-erative evaluation and treatment guidance.