三维时间飞跃法磁共振血管成像对微血管减压术的临床指导意义

发布时间：2018-04-25 15:13

本文选题：三维时间飞跃法磁共振血管成像 + 微血管减压术　；参考：《吉林大学》2017年硕士论文

【摘要】：背景:随着显微镜技术在外科手术中的广泛使用,微血管减压术由于其安全有效得以迅速在临床上推广。近年来,在原发性面肌痉挛及原发性三叉神经痛的治疗中微血管减压术取得了良好的疗效,由于微血管减压术能够更完善地保留神经功能,其治愈率较高,复发率较低,临床效果肯定,微血管减压术已成为国内外均认可的治疗原发性面肌痉挛及原发性三叉神经痛的首选方法。三维时间飞跃法磁共振血管成像是一种全新的无创性血管成像方法,利用核磁共振成像技术对桥小脑角区的血管及神经路径进行扫描,能够显示桥小脑角区血管与神经的三维空间关系。本研究通过回顾性分析,进一步研讨三维时间飞跃法磁共振血管成像对微血管减压术治疗原发性面肌痉挛及原发性三叉神经痛的临床指导意义。目的:观察三维时间飞跃法磁共振血管成像(3D-TOF-MRA)对桥小脑角区血管与神经三维空间关系的显示,与微血管减压术(MVD)中所见的血管与神经三维空间关系进行对比,探讨3D-TOF-MRA对微血管减压术的临床指导意义。方法:回顾性分析36例自2016年6月~2017年2月于吉林大学第二医院神经外一科行MVD治疗原发性面肌痉挛(HFS)及原发性三叉神经痛(TN)的患者的临床资料。术前均给予患者行3D-TOF-MRA检查,通过3D-TOF-MRA判定压迫神经的责任血管,并与MVD术中所见的实际情况进行比较。结果:本组36例患者中有33例患者于术前行3D-TOF-MRA检查后发现有明显的责任血管压迫面神经或三叉神经,其中责任血管为小脑前下动脉12例、小脑后下动脉11例、小脑前下动脉联合椎动脉5例、小脑上动脉5例;其中有31例在MVD术中证实有相同的血管压迫神经情况。有3例患者术前行3D-TOF-MRA检查后未发现有明显的责任血管,术中证实为小脑前下动脉、小脑后下动脉和小脑上动脉的较细分支压迫面神经或三叉神经。有2例TN患者行3D-TOF-MRA检查所示小脑上动脉压迫三叉神经,而术中所见为小脑上动脉联合静脉压迫三叉神经。本组资料中3D-TOF-MRA与术中结果在责任血管的判定上比较,经统计学分析,差异无统计学意义(P0.05)。使用术中结果诊断原发性面肌痉挛及原发性三叉神经痛患者的阳性率为100%(36/36)。应用3D-TOF-MRA诊断原发性面肌痉挛及原发性三叉神经痛患者的阳性率为91.67%(33/36)。经统计学分析,3D-TOF-MRA与术中责任血管检测结果对原发性面肌痉挛和原发性三叉神经痛的诊断具有高度的一致性(K=0.92)。结论:3D-TOF-MRA能够清晰地显示桥小脑角区血管和神经的三维空间关系,可作为诊断原发性面肌痉挛及原发性三叉神经痛的方法之一。术前进行3D-TOF-MRA检查,可以明确HFS与TN的病因,初步判定责任血管,指导MVD手术操作,提高手术质量,确保手术疗效。
[Abstract]:Background: microvascular decompression has been widely used in surgery due to its safety and efficacy. In recent years, microvascular decompression has achieved good results in the treatment of primary hemifacial spasm and trigeminal neuralgia. Microvascular decompression has become the first choice in the treatment of primary hemifacial spasm and trigeminal neuralgia. Magnetic resonance angiography (MRA) is a novel and noninvasive imaging method. Magnetic resonance imaging (MRI) is used to scan the vessels and nerve pathways in the cerebellopontine angle area. It can show the three-dimensional spatial relationship between the vessels and nerves in the cerebellopontine angle area. The purpose of this study was to study the clinical significance of three dimensional time leap magnetic resonance angiography (MRA) in the treatment of primary facial spasm and trigeminal neuralgia by microvascular decompression in the treatment of primary hemifacial spasm and trigeminal neuralgia. Objective: to observe the display of three-dimensional spatial relationship between the vessels and nerves in the cerebellopontine angle area by 3D-TOF-MRA-3D-TOF-MRAA, and to compare it with the three-dimensional spatial relationship between the vessels and nerves in microvascular decompression. To explore the clinical significance of 3D-TOF-MRA in microvascular decompression. Methods: the clinical data of 36 patients with primary hemifacial spasm and primary trigeminal neuralgia treated with MVD from June 2016 to February 2017 in the Department of Neurology, second Hospital of Jilin University were retrospectively analyzed. Patients were examined with 3D-TOF-MRA before operation, and the responsible vessels of nerve compression were judged by 3D-TOF-MRA, and compared with the actual situation during MVD. Results: 33 of the 36 patients underwent 3D-TOF-MRA examination before operation and found that there were obvious responsible vessels pressing facial nerve or trigeminal nerve. The responsible vessels were anterior inferior cerebellar artery in 12 cases, posterior inferior cerebellar artery in 11 cases, and anterior inferior cerebellar artery in 12 cases, and posterior inferior cerebellar artery in 11 cases. There were 5 cases of anterior inferior cerebellar artery combined with vertebral artery and 5 cases of superior cerebellar artery, among which 31 cases were confirmed to have the same vascular compression during MVD. In 3 cases, there were no obvious responsible vessels after 3D-TOF-MRA examination before operation. It was proved to be a fine branch of the anterior inferior cerebellar artery, posterior inferior cerebellar artery and superior cerebellar artery to compress the facial nerve or trigeminal nerve. In 2 patients with TN, the superior cerebellar artery compressed the trigeminal nerve, and the superior cerebellar artery combined with the vein compressed the trigeminal nerve. In this group, 3D-TOF-MRA was compared with operative results in the judgment of responsible vessels. There was no significant difference between 3D-TOF-MRA and operative results (P 0.05). The positive rate of intraoperative diagnosis of primary hemifacial spasm and trigeminal neuralgia was 100 / 36 / 36. The positive rate of 3D-TOF-MRA in the diagnosis of primary hemifacial spasm and trigeminal neuralgia was 91.67 / 36. The results of statistical analysis of 3D-TOF-MRA and intraoperative responsible vascular examination were highly consistent in the diagnosis of primary hemifacial spasm and primary trigeminal neuralgia. Conclusion the three dimensional spatial relationship of the vessels and nerves in cerebellopontine angle area can be clearly demonstrated by the 3 D TOF MRA, which can be used as one of the methods for the diagnosis of primary hemifacial spasm and trigeminal neuralgia. 3D-TOF-MRA examination before operation can determine the etiology of HFS and TN, determine the responsible blood vessels, guide the operation of MVD, improve the quality of operation and ensure the curative effect.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.3

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