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目的:评价磁共振断层血管成像(magnetic resonance tomographic angiography,MRTA)显示桥小脑角区脑神经与血管的三维空间关系的能力及对血管压迫性三叉神经痛和面肌痉挛病因诊断的价值。方法:回顾性分析210例患者(其中三叉神经痛178例,面肌痉挛32例)术前MRTA影像学表现及微血管减压(microvascular decompression,MVD)术中所见责任血管结果。结果:MRTA重建可以直观地显示桥小脑角脑神经与血管的三维立体的图像,再现局部脑神经与血管解剖结构。210例症状侧术前MRTA检查有血管压迫者为157侧,血管与神经接触密切者为35侧,共192侧,敏感性为91.4%。手术中发现有血管压迫或接触者202侧,其中动脉责任血管187侧,静脉责任血管9侧,动静脉双重责任7侧。MRTA检查诊断神经血管压迫和接触的特异性分别为98.7%(155/157)和94.3%(33/35),其余4侧仅见蛛网膜增厚,而血管与神经之间接触不密切。MRTA未能发现但手术中证实存在血管压迫或接触者14侧,其责任血管均为静脉或小动脉。结论:高分辨MRTA成像结合3D后处理重建能清晰显示三叉神经和面听神经脑池段与周围血管的空间关系,对明确三叉神经痛或面肌痉挛的病因诊断有重要价值,可为术前筛选手术病人及优化MVD手术提供可靠的影像学依据。
OBJECTIVE: To evaluate the ability of magnetic resonance tomographic angiography (MRTA) to demonstrate the three-dimensional spatial relationship of the cranial nerves and blood vessels in the cerebellopontine angle and to evaluate the etiologic diagnosis of vascular compression trigeminal neuralgia and hemifacial spasm. Methods: The preoperative MRTA findings of 210 patients (including 178 cases of trigeminal neuralgia and 32 cases of hemifacial spasm) were retrospectively analyzed. The results of responsible vascular findings in microvascular decompression (MVD) were retrospectively analyzed. Results: MRTA reconstruction can visually display the three-dimensional images of the cerebellopontine angle and blood vessels, and reproduce the local cranial nerves and vascular anatomy. 210 patients with symptoms of preoperative MRTA were vascular oppression of 157 side, blood vessels and nerve close contact with 35 sides, a total of 192 sides, the sensitivity was 91.4%. Surgery was found to have vascular compression or contact 202 side, including 187 vessels of arterial responsibility, 9 vessels of venous responsibility, and 7 sides of arteriovenous dual responsibility. The specificity of MRTA in diagnosing neurovascular compression and contact were 98.7% (155/157) and 94.3% (33/35), respectively. The other 4 sides only showed arachnoid thickening, but the contact between blood vessels and nerves was not close. MRTA failed to find but the operation confirmed the existence of vascular compression or contact 14 side, the responsibility of the vessels are veins or arterioles. Conclusion: High-resolution MRTA combined with 3D post-processing reconstruction can clearly show the spatial relationship between the trigeminal nerve and the facial nerve segment of the auditory nerve and the surrounding blood vessels. It is of great value in the etiological diagnosis of trigeminal neuralgia or hemifacial spasm. Surgical patients and optimize MVD surgery provide a reliable imaging basis.