多平面重组联合选择性后循环血管重建对原发性三叉神经痛受累神经和责任血管的诊断价值
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摘要
目的:探讨多平面重组联合选择性后循环血管重建技术对原发性三叉神经痛患者的受累神经定侧及其责任血管判定的诊断价值。方法:回顾性分析经微血管减压术证实的67例单侧原发性三叉神经痛患者的临床及磁共振断层血管成像(MRTA)资料,所有患者均于术前行3D-TOF-SPGR和3D-FIESTA序列扫描,将神经过渡区接触作为一个重要的判断依据纳入诊断标准中,分别采用常规轴面影像分析和多平面重组联合选择性后循环血管重建的分析方法来判断受累神经及责任血管,以术中所见为金标准,对比两种影像分析方法对受累神经及责任血管诊断的准确性。结果:多平面重组联合选择性后循环血管重建诊断受累神经和责任血管的准确率分别为92.54%和76.12%;而常规轴面影像分析诊断受累神经和责任血管的准确率分别为76.12%和55.22%。这两种方法在诊断受累神经和责任血管方面均存在显著性差异(P=0.007和P=0.013)。结论:多平面重组联合选择性后循环血管重建技术可以在术前显著提高原发性三叉神经痛患者受累神经及其责任血管诊断的准确性,从而有助于治疗计划的完善制定。
Objective:To investigate the diagnostic value of the multiplanar reformation combined with selective vertebrobasilar arterial system reconstruction in classical trigeminal neuralgia.Method:67 patients with unilateral classical trigeminal neuralgia were included.All patients underwent magnetic resonance tomographic angiography(MRTA)of trigeminal nerve preoperatively,including3 D-TOF-SPGR and 3 D-FIESTA.The conventional axial MRI analysis and the multiplanar reformation combined with selective vertebrobasilar arterial system reconstruction were used to predict the involved nerves and responsible vessels respectively.The neural transition zone contact was included as a new important criterion for neurovascular compression syndrome diagnosis.The involved nerves and responsible vessels were confirmed during the cranial neurovascular decompression.The results of these two analysis methods were compared to the clinical symptoms and surgery to evaluate the consistency.The diagnostic accuracy of these two analysis methods in evaluation for the involved nerve and the responsible vessel were compared using the paired Chi-square test.Results:The accuracy of the multiplanar reformation combined with selective vertebrobasilar arterial system reconstruction for diagnosing involved nerves and responsible vessels were 92.54%and 76.12%respectively.In contrast,the accuracy of the conventional axial MRI analysis in diagnosing involved nerves and responsible vessels were 76.12%and 55.22%.There were significant differences between these two methods in the diagnosis of both involved nerves and responsible vessels(P=0.007 and P=0.013).Conclusion:Multiplanar reformation combined with selective vertebrobasilar arterial system reconstruction can greatly improve the diagnostic accuracy for the involved nerves and responsible vessels in patients with unilateral classical trigeminal neuralgia preoperatively,which is helpful to make better treatment plans for these patients.
Objective:To investigate the diagnostic value of the multiplanar reformation combined with selective vertebrobasilar arterial system reconstruction in classical trigeminal neuralgia.Method:67 patients with unilateral classical trigeminal neuralgia were included.All patients underwent magnetic resonance tomographic angiography(MRTA)of trigeminal nerve preoperatively,including3 D-TOF-SPGR and 3 D-FIESTA.The conventional axial MRI analysis and the multiplanar reformation combined with selective vertebrobasilar arterial system reconstruction were used to predict the involved nerves and responsible vessels respectively.The neural transition zone contact was included as a new important criterion for neurovascular compression syndrome diagnosis.The involved nerves and responsible vessels were confirmed during the cranial neurovascular decompression.The results of these two analysis methods were compared to the clinical symptoms and surgery to evaluate the consistency.The diagnostic accuracy of these two analysis methods in evaluation for the involved nerve and the responsible vessel were compared using the paired Chi-square test.Results:The accuracy of the multiplanar reformation combined with selective vertebrobasilar arterial system reconstruction for diagnosing involved nerves and responsible vessels were 92.54%and 76.12%respectively.In contrast,the accuracy of the conventional axial MRI analysis in diagnosing involved nerves and responsible vessels were 76.12%and 55.22%.There were significant differences between these two methods in the diagnosis of both involved nerves and responsible vessels(P=0.007 and P=0.013).Conclusion:Multiplanar reformation combined with selective vertebrobasilar arterial system reconstruction can greatly improve the diagnostic accuracy for the involved nerves and responsible vessels in patients with unilateral classical trigeminal neuralgia preoperatively,which is helpful to make better treatment plans for these patients.
引文
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[5]赵豪杰,胡娟,王维哲,等.三叉神经痛微血管减压术(MVD)术后无效的原因分析[J].新疆医学,2013,43(7):85-86.
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[8]Guclu B,Sindou M,Meyronet D,et al.Cranial nerve vascular compression syndromes of the trigeminal,facial and vago-glossopharyngeal nerves:comparative anatomical study of the central myelin portion and transitional zone;correlations with incidences of corresponding hyperactive dysfunctional syndromes[J].Acta Neurochir(Wien),2011,153(12):2365-2375.
[9]闫锐,王宏,郭佑民,等.血管压迫性偏侧面肌痉挛的MRI诊断[J].实用放射学杂志,2008,24(5):589-591.
[10]王清,张振光,李宗芳,等.血管压迫性原发性三叉神经痛压迫位点与面部痛区关系的MRI研究[J].中国医学影像技术,2018,34(4):499-503.
[2]The International Classification of Headache Disorders,3rd edition(beta version)[J].Cephalalgia,2013,33(9):629-808.
[3]Haller S,Etienne L,Kovari E,et al.Imaging of neurovascular compression syndromes:trigeminal neuralgia,hemifacial spasm,vestibular paroxysmia,and glossopharyngeal neuralgia[J].AJNR,2016,37(8):1384-1392.
[4]Sekula RF Jr,Frederickson AM,Jannetta PJ,et al.Microvascular decompression for elderly patients with trigeminal neuralgia:a prospective study and systematic review with meta-analysis[J].JNeurosurg,2011,114(1):172-179.
[5]赵豪杰,胡娟,王维哲,等.三叉神经痛微血管减压术(MVD)术后无效的原因分析[J].新疆医学,2013,43(7):85-86.
[6]Donahue JH,Ornan DA,Mukherjee S.Imaging of vascular compression syndromes[J].Radiol Clin North Am,2017,55(1):123-138.
[7]谭令,柴维敏,宋琦,等.血管压迫性三叉神经痛的MRI研究[J].中华放射学杂志,2006,40(12):1250-1253.
[8]Guclu B,Sindou M,Meyronet D,et al.Cranial nerve vascular compression syndromes of the trigeminal,facial and vago-glossopharyngeal nerves:comparative anatomical study of the central myelin portion and transitional zone;correlations with incidences of corresponding hyperactive dysfunctional syndromes[J].Acta Neurochir(Wien),2011,153(12):2365-2375.
[9]闫锐,王宏,郭佑民,等.血管压迫性偏侧面肌痉挛的MRI诊断[J].实用放射学杂志,2008,24(5):589-591.
[10]王清,张振光,李宗芳,等.血管压迫性原发性三叉神经痛压迫位点与面部痛区关系的MRI研究[J].中国医学影像技术,2018,34(4):499-503.