磁共振对因神经血管压迫致三叉神经痛的诊断价值

目的分析原发性三叉神经痛患者的MR表现，探讨MRI对因神经血管压迫致原发性三叉神经痛的诊断价值。方法回顾性分析12例三叉神经痛患者的MRI表现，就三叉神经和周围血管的关系与手术结果进行对照分析。结果12例三叉神经痛患者的MRI资料中，神经血管压迫、接触或可疑接触者11例，占91．7％；该12例患者均行手术，证实血管压迫或接触者12例；故与手术结果对照，MRI诊断三叉神经痛神经血管压迫或接触的敏感性为91．7％。结论MRI能清晰显示三叉神经脑池段与毗邻血管之间的关系，对三叉神经血管压迫或接触的诊断具有较高的敏感性，对提供术前评估和指导治疗有极其重要的意义。     

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。     

磁共振对因神经血管压迫致三叉神经痛的诊断价值分析

目的：探讨核磁共振（M RI）对于神经血管压迫性三叉神经痛（T N ）的诊断价值。方法60例T N患者作为T N组，30例健康志愿者作为对照组，采用M RI技术进行检查，分析三叉神经与周围血管之间的关系，检查结果与手术所见进行比较。结果 T N组经M RI检查显示阳性率为95.00％，显著高于对照组的23.33％（P＜0.05）；T N组60例患者均经手术证实为神经血管压迫，经M RI检查显示57例存在神经血管压迫、接触或可疑接触，M RI诊断敏感性为95.00％。结论 M RI能够直观、清晰地显示三叉神经与周围血管之间的关系，对于诊断三叉神经血管压迫或接触具有高度敏感性，对TN的术前评估及治疗方案选择具有指导价值。     

三维时间飞跃法MRA及图像后处理技术对血管压迫性三叉神经痛的诊断价值

目的　探讨三维时间飞跃法磁共振血管成像 (3D TOFMRA)及其后处理技术 (MPR)对血管压迫性三叉神经痛的诊断价值。方法　两名神经放射科医师盲法分析 38例临床诊断为三叉神经痛患者的 3D TOFMRA基础图像及MPR图像。结果　 (1) 38例三叉神经痛患者中 ,MRI诊断为血管接触或压迫 31例 ,其中有症状侧血管接触或压迫 2 6例。症状侧与影像上三叉神经存在血管接触或压迫有显著相关 (P <0 0 0 5 )。(2 ) 14例以三叉神经第 2支分布区域疼痛为主要症状的患者中 ,85 .7% (12例 )血管压迫神经的中间部位 ;10例以三叉神经第 3支分布区域疼痛为主要症状的患者中 ,70 % (7例 )血管压迫神经的侧方 (P <0 0 0 5 )。结论　 3D TOFMRA及MPR可清晰地显示三叉神经脑池段与毗临血管的关系 ,血管压迫神经的部位与疼痛的区域有一定的相关性     

桥脑旁三叉神经微血管与临床关系的研究

目的：研究三叉神经与桥脑旁微血管的临床解剖关系。方法：总结比较３０例尸检与６０例接受微血管减压手术的三叉神经痛病人的三叉神经与桥脑旁微血管的关系，共可分为五型：无接触、接触、压迫、粘连包绕和贯穿型。结果：尸检和手术中所见的微血管与三叉神经关系有明显区别。三叉神经痛的手术病人组血管压迫神经者１００％，尸检组仅４５％。结论：血管压迫因素是三叉神经痛的重要发病因素。     

磁共振三叉神经成像在三叉神经痛诊断中的应用

目的探究磁共振三叉神经成像在三叉神经痛诊断中的应用。方法回顾性分析2012-01—2014-01我院接受治疗的88例三叉神经痛(单侧疼痛)患者的临床资料,给予所有患者T1-VIBE和T2-SPC两个序列的磁共振三叉神经成像检查,分析磁共振三叉神经成像显示的三叉神经血管压迫和患者临床症状的关系,并分析磁共振三叉神经检查在临床中的应用价值。结果 35例患者三叉神经的血管压迫与临床症状有密切关系,且均为单侧临床症状,31例患者的MRI图像显示有听神经血管接触或压迫。且35例患者中,对于无症状侧29例患者未见听神经血管接触或压迫。比较差异具有统计学意义(P0.05)。结论给予三叉神经痛患者磁共振三叉神经成像能够清晰的显示出两侧三叉神经血管压迫情况,对临床具有较佳的指导作用,可以在临床中进一步推广和使用。     

原发性三叉神经痛伽玛刀治疗后MRI改变及疗效

目的观察原发性三叉神经痛伽玛刀治疗后MRI表现及探讨疗效的病因。方法随访12例原发性三叉神经痛患者伽玛刀治疗后12至30个月复查,行头颅MRI 3D-FISP序列簿层扫描,采用测量法确定三叉神经根、血管以及脑干的解剖改变,与治疗前进行对照。结果所有患者治疗后脑干测量与治疗前无改变;7例治疗前可见责任血管,治疗后依然存在。所有患者治疗后MRI可观察到治疗侧呈较低信号改变及三叉神经根截面面积萎缩,神经萎缩率为39.8%。三叉神经痛的缓解与神经萎缩的过程相吻合。结论伽玛刀治疗原发性三叉神经痛可造成治疗部位三叉神经根萎缩及神经退行性改变,从而达到缓解患者疼痛的临床症状,治疗效果与神经血管减压术相似。因此,认为三叉神经萎缩性改变是导致三叉神经痛缓解的原因之一。     

磁共振对原发性三叉神经痛的诊断及意义

原发性三叉神经痛(trigeminal neuralgia，TN)是脑神经病变中最常见的一种，大多具有典型的临床特征，多发于40岁以上及老年人，女性多于男性。导致三叉神经痛的因素有多种，目前神经血管压迫作为原发性三叉神经痛病因已得到大多数学者接受。由于MRI具有较高的软组织分辨力、多平面、多参数成像等特点，因而成为脑神经及其相关结构的最佳成像方法。本文对临床诊断为三叉神经痛的12例患者的MRI表现及手术结果进行回顾性对照分析，旨在探讨MR对三叉神经痛的诊断价值及意义。     

微血管减压术治疗原发性典型与不典型三叉神经痛对比研究

目的探讨原发性典型与不典型三叉神经痛微血管减压术治疗的临床效果。方法选择原发性典型与不典型三叉神经痛患者各40例,在全身麻醉气管插管下完成微血管减压术,比较2组术中所见血管压迫来源、压迫程度及血管压迫位置。结果典型三叉神经痛组压迫血管来源为单纯动脉占85.0%,显著高于非典型三叉神经痛组的57.5%(P0.05);来源为动静脉混合占15.0%,显著低于非典型三叉神经痛组的42.5%(P0.05);典型三叉神经痛组血管与神经位置接触者显著高于非典型三叉神经痛者(P0.05),术中发生三叉神经出现萎缩者比例显著少于非典型三叉神经痛者(P0.05),典型三叉神经痛者其压迫血管在近端者显著多于非典型三叉神经痛者(P0.05),压迫血管在远端者显著少于非典型三叉神经痛者(P0.05)。结论原发性三叉神经痛实施血管减压术,术前鉴定其发病特点,在预测其压迫血管类型、位置及其与神经的关系具有一定临床价值。     

磁共振3D-SPACE在原发性三叉神经痛诊断中的应用

目的探讨MR变翻转角的三维快速自旋回波序列(3D-SPACE)对原发性三叉神经痛的应用价值。方法对39例原发性三叉神经痛患者于1.5T磁共振扫描仪上行3D-SPACE序列成像并多平面重建,分析患侧组与健侧组三叉神经与邻近血管关系。结果原发性三叉神经痛患侧组39侧神经,31例(31/39)表现为神经受压或移位;健侧39侧神经,25例(25/39)表现为神经血管关系阴性;健侧组与患侧组神经血管关系密切阳性率及三叉神经受压推移率的差异具有统计学意义(P0.05)。结论 3D-SPACE序列可以清晰显示三叉神经与邻近血管的关系,为临床治疗及决策提供更准确的影像学诊断依据。     

The significance of three-dimensional MR-defined neurovascular compression for the pathogenesis of trigeminal neuralgia

Three-dimensional MR tomography was used to examine the relationship between symptoms of trigeminal neuralgia and neurovascular compression of the nerve in 18 patients. The intensity of neurovascular interaction was classified according to neuroradiological criteria. We found that a radiologically defined compression or dislocation of the nerve by an artery was always associated with symptoms of trigeminal neuralgia. A simple contanct between vessel and nerve, however, was also observed on the asymptomatic sides of 10 out of 18 patients. In 6 of 18 patients, in contrast, trigeminal neuralgia was present in spite of the absence of neurovascular contact. In accordance with a cited study based on autopsy and intraoperative findings, our findings indicate that, in a certain proportion of cases, trigeminal neuralgia may be caused by neurovascular compression alone, whereas in other cases, other pathogenetic factors may be involved to a varying degree or be even exclusively responsible for the development of trigeminal neuralgia. The possible significance of the method for a preoperative estimation of the success of microvascular decompression of the trigeminal nerve is discussed.     

高分辨率强化3D - SPGR序列评价三叉神经痛患者神经血管的关系

目的 探讨强化三维损毁梯度回波( 3D - SPGR)序列检出三叉神经痛(TN)患者神经血管压迫(NVC)的能力.方法 对37例TN患者行强化3D- SPGR序列扫描,由高年资神经影像学医师评价三叉神经根进入区(REZ)神经与血管的关系,并与显微血管减压术(MVD)术中观察的结果对比.结果 37例患者中,MVD证实36例存在NVC,强化3D-SPGR显示了35例,其敏感性为97.2％,特异性为100％,且MRI所显示的责任血管位置与MVD之间有高度的一致性(K=0.81).在14例三叉神经上颌支疼痛的患者中,12例(85.7％)的NVC位于REZ的内侧,而在16例下颌支疼痛的患者中,13例(81.3％)的NVC位于REZ的外侧,两者之间的差异有统计学意义(P＜0.001).结论 强化3D - SPGR序列是检出TN患者NVC有效的检查方法,将为MVD术前制定治疗方案提供有价值的信息.     

磁共振T1加权三维选择性水激发成像在三叉神经痛诊断中的应用

目的：评价磁共振T1加权三维选择性水激发（MR T1W 3D-WATS）成像在颅内血管压迫性三叉神经痛诊断中的应用价值。方法：14例三叉神经痛患者和6名正常志愿者行MR T1W 3D-WATS扫描及多平面重组,观察三叉神经与邻近血管的关系。结果：MRI示14例三叉神经痛患者中,单侧三叉神经受压右侧2例、左侧6例;双侧均受压5例,其中1例为双侧疼痛,仅有右侧或左侧疼痛的单侧疼痛各2例;1例患者两侧三叉神经均未见明显受压,但临床有明显右侧三叉神经痛症状。志愿者中,有受压现象者左、右侧各1例。三叉神经受颅内血管压迫与临床表现有明显相关性（P=0.03,r=0.84）。责任血管分别为小脑上动脉13/19支,小脑前下动脉1/19支,基底动脉1/19支,起源不清血管4/19支。结论：MR T1W 3D-WATS成像能够清楚显示三叉神经与邻近血管的关系,为临床颅内血管压迫性三叉神经痛的诊断提供依据。     

Preoperative detection of the neurovascular relationship in trigeminal neuralgia using three-dimensional fast imaging employing steady-state acquisition (FIESTA) and magnetic resonance angiography (MRA)

Microvascular decompression is an accepted treatment for trigeminal neuralgia (TN). Preoperative identification of neurovascular compression, therefore, could aid determination of the appropriate treatment for TN. To preoperatively visualize the neurovascular relationship, three-dimensional fast imaging employing steady-state acquisition (3D FIESTA) and magnetic resonance angiography (MRA) were performed on 37 patients with TN in our study. 3D FIESTA in combination with MRA identified surgically verified neurovascular contact in 35 of 36 symptomatic nerves. The offending vessel (artery or vein) was correctly identified in 94.4% of patients, and agreement between preoperative MRI visualization and surgical findings was excellent (k = 0.92; 95% confidence interval, 0.67–1.00). Thus, 3D FIESTA in combination with MRA is useful in the detection of vascular contact with the trigeminal nerve in patients with TN.     

原发性三叉神经痛特征性MRI序列检查的临床应用

目的探讨磁共振断层血管成像(MRTA)不同成像序列在诊断三叉神经痛血管神经压迫的价值。方法回顾分析128例原发性三叉神经痛病人的临床资料,全部行微血管减压术(MVD)。术前均行MRTA检查,运用三维时间飞跃成像序列(3D-TOF)、超快平衡场回波序列(B-TFE)、T1高分辨率各向同性容积激发序列(THRIVE)及最大密度投影法(MIP)重建,观察血管神经走行关系,并与术中所见进行对比。结果 MRTA检查共发现责任血管115例,三叉神经无血管压迫13例;术中观察发现责任血管122例,三叉神经无血管压迫6例。MRTA检查与术中观察情况一致121例(95%)。本组治愈106例,显效15例,有效5例,无效2例。结论 MRTA检查对发现原发性三叉神经痛的责任血管与神经关系具有重要价值,3D-TOF、B-TFE、THRIVE及MIP序列扫描可显示责任血管,并具有较高的准确性,对术前评估和指导手术具有重要意义。     

An anatomical study of the neurovascular relationships at the trigeminal root entry zone

We aimed to study the neurovascular relationships at the trigeminal root entry zone in the normal population to help determine the pathogenesis of trigeminal neuralgia. We studied 50 fresh cadavers asymptomatic for trigeminal neuralgia or other facial pain during life and examined the 100 trigeminal root entry zones (REZ) using either a transtentorial (34 cadavers) or an infratentorial approach (16 cadavers). A vascular relationship was seen in 39 REZ (39%). There was an arterial relationship in 34 REZ (superior cerebellar artery in 23, anterior inferior cerebellar artery in 7, and pontine branches of the basilar artery in 4). A venous relationship was seen in 5 REZ. There was vascular contact only in 28 REZ, displacement of the nerve in 7 and grooving of the nerve in 4. We concluded that a neurovascular relationship at the trigeminal root entry zone is not uncommon in an asymptomatic population. The incidence of a vascular relationship in the Indian population seems similar to that in other major series. Electron microscopic studies of the nerve at the site of vascular contact in normal and symptomatic populations may help determine the exact pathogenesis of trigeminal neuralgia.     

Enhanced three-dimensional fast spoiled gradient recalled MRI combined with magnetic resonance angiography for preoperative assessment of patients with trigeminal neuralgia

Microvascular decompression (MVD) is now a standard treatment for trigeminal neuralgia (tic douloureux). The goal of MVD is to decompress the trigeminal root from offending vessels, aiming at a permanent cure with no or little sensory deficit. Preoperative identification of neurovascular compression, therefore, has potentially important implications for patient selection, surgical planning, and outcomes. In this study, enhanced three-dimensional fast spoiled gradient recalled MRI and three-dimensional magnetic resonance angiography with a 3.0-Tesla MRI system were used to detect the anatomic relationship of neural and vascular structures at the trigeminal root entry zone (TREZ) preoperatively. In 27 of 29 patients (93%), surgical findings were consistent with the imaging results. All patients treated with MVD achieved complete pain relief. The usefulness of high-resolution MRI in revealing the neurovascular contact at the TREZ was demonstrated, and it could be used to facilitate the selection of treatment modality. Thus, MVD can be chosen for patients who are most likely to benefit from this intracranial procedure.     

Association between trigeminal neuralgia and multiple sclerosis: role of magnetic resonance imaging.

Seven consecutive patients with multiple sclerosis and trigeminal neuralgia were investigated with MRI to determine the occurrence of a lesion which would account for the patients' pain. Two patients had bilateral symptoms. In the patients with unilateral trigeminal neuralgia vascular compression of the nerve by an artery at the root entry zone on the symptomatic side was confirmed in three patients and an epidermoid tumour distorting the nerve on the symptomatic side was identified in one patient. A demyelinating plaque was identified in only one patient, affecting the trigeminal nerve at the root entry zone at the pons. In those with bilateral symptoms neurovascular compression was identified on both sides in one patient and on one side only in the remaining patient. Microvascular decompression cured the pain in two patients with neurovascular compression. The variable aetiology of trigeminal neuralgia is stressed even in patients with coexistent neurological conditions such as multiple sclerosis, which can cause trigeminal neuralgia independent of other causes.     

微血管减压术治疗脑神经血管压迫综合征

目的 总结和分析微血管减压术(MVD)治疗脑神经血管压迫综合征的疗效与术后并发症. 方法 应用MVD治疗脑神经血管压迫综合征39例(三又神经痛19例,面肌痉挛18例,舌咽神经痛2例)并探讨手术技巧及术后并发症的防治.结果 2例舌咽神经痛患者和17例三叉神经痛患者术后疼痛立即消失,面肌痉挛患者中有16例术后痉挛立即消失.术后无血肿、感染、脑脊液漏、偏瘫和死亡病例.34例获随访,平均随访1.58年,其中32例效果良好. 结论 MVD治疗脑神经血管压迫综合征安全、微创、有效,是目前治疗脑神经血管压迫综合征的首选方法.