Correlative Study And Follow-Up Results Of Preoperative And Postoperative 3D-TOF MRA And Operative Results Of MVD For Trigeminal Neuralgia

PART I Correlative study of preoperative 3D-TOF MRA and operative results in trigeminal neuralgiaObjective:Comparative Analysis on Findings between 3D Time of Flight in the visualization of neurovascular compression (NVC) and Microvascular Decompression (MVD)Surgery, aims to assess the value of 3D-TOF MRA in vascular compression of trigeminal neuralgia in the diagnosis and MVD preoperative instruction significance.Methods:Retrospective analysis 53 cases of patients with trigeminal neuralgia who visited our hospital from September 2012 to September 2015,all of the patients have unilateral,and be treated with microvascular decompression (MVD) of the trigeminal nerve.All patients undergoing routine MRI screening the surrounding area of trigeminal nerve vascular compression of the trigeminal nerve pathological changes after on the scan 3D-TOF MRA sequence.determine the trigeminal contorts the presence of vascular compression or contact, and analysis responsibility the source of the blood vessels.Compared with trigeminal neuralgia in MVD can see with 3D-TOF MRA can see nerve blood vessels.Result:53 patients with trigeminal neuralgia who scan 3D-TOF MRA,2 cases are not found vascular compression or contact,51 cases are found vascular compression or contact.51 cases of liability for superior cerebellar artery vascular source distribution 13 cases,anterior artery 6 cases, after cerebellar artery 4 cases, vertebral artery 4 cases,vein and artery in 5 cases.53 underwent microvascular decompression,52 cases showed neurovascular compression or contact,1 case showed no nerve vascular compression or contact. This group of data in 3D-TOF-MRA diagnosis sensitivity TN patients was 98.08%. the missed diagnosis rate was 1.92%.Agreement between the offending vessels defined by 3D-TOF MRA and findings at surgery was good (K= 0.91).Conclusion:It has a high degree of consistency between the offending vessels and in the visualization of neurovascular compression (NVC) by 3D-TOF MRA and findings at surgery.3D-TOF MRA can be used as a clinical diagnosis of trigeminal neuralgia of one of the standard,and can be used for MVD preoperative instruction.PART Ⅱ The relationship between preoperative 3D-TOF MRA and the instant outcome of microvacular decompression in trigeminal neuralgia Objective:To analysis the preoperative neurovascular compression(NVC) and the instant outcome of microvacular decompression(MVD),aims to assess the relationship.Methods:The subjects were 28 patients with TN who visited our hospital from February 2013 to September 2014,all of the patients have unilateral,and be treated with microvascular decompression (MVD) of the trigeminal nerve. All patients undergoing routine MRI screening the surrounding area of trigeminal nerve vascular compression of the trigeminal nerve pathological changes after on the scan 3D-TOF MRA sequence.All radiographic images are obtained by 2 experienced radiologists were analyzed.According to the relationship between the trigeminal nerve and the offending vessel, we made the standard of scoring:0’-no relationship between the nerve and the vessel or the vague relationship difficult to evaluate; l’-the vessel crossing or touching the nerve without a visible layer of cerebrospinal fluid and without any deformity of the root;2’-a marked indentation on the root by the compression of the vessel;3’-a distortion and/or a displacement of the root by comparing with the asymptomatic side.Three scores separately from axial,oblique sagittal, and coronal images were added together.The degree of severity of the compression was classified as follows: grade 0 (0’～l’),no NVC;grade 1 (2’-3’),suspicious NVC;grade 2 (4’～6’), moderate NVC; grade3 (7’～9’),serious NVC.And the correlation analysis of MVD with instant outcomes after operation.Result:28 patients who undergoing 3D-TOF MRA screening before the microvascular decompression (MVD),the NVC compression degree showed grade 0,grade 1,grade 2,grade 3:2 cases,6 cases,15 cases,5 cases.In 28 cases of patients with undergoing MVD showed the pain instantly disappear have 22 cases,4 cases pain relieved, taking carbamazepine can get control the pain,the effective rate is 92.86%.2 cases is still pain as same as before MVD.The instant effectiveness of MVD in different preoperative NVC groups had no significant difference(X2=4.223, P> 0.05).Conclusion:3D-TOF MRA successfully demonsated it’s usefulness in detecting the neurovascular contact at the trigeminal root entry zonethereby facilitating the selection of patients who were most likely to benefit from MVD.MVD is effective for different NVC grade.PART Ⅲ The relationship between postoperative 3D-TOF MRA and the long-term outcome of microvacular decompression in trigeminal neuralgiaObjective:This study aimed to find out the value of 3D-TOF MRA in predicting the long-term outcome of microvacular decompression(MVD) for trigeminal neuralgia (TN)Methods:All clinical data, preoperative NVC date of 3D-TOF MRA, MVD were the same as the part Ⅱ.All patients were taken 3D-TOF MRA at 1 week after operations,and recorded the NVC date.We defined "relief rate of NVC"=(preoperative score-postoperative score)/ preoperative score.In addition, we divided the cases into 3 groups:group>75%;<50%<group P≤75%; group γ≤50%.According to Barrow’s classification,the surgical outcome was assessed 6 mouths-2 years (average 13.2mouths) postoperatively. The correlation analysis of MVD with long-term outcomes after operation.Result:Preoperative NVC date of 3D-TOF MRA was the same as the part Ⅱ.28 patients with trigeminal neuralgia who scan 3D-TOF MRA at 1 week after operations,16 cases are not found vascular compression or contact,9 cases are found suspicious vascular compression or contac,3 cases are found vascular compression or contact.1 week after operations,the NVC compression degree showed grade 0,grade 1,grade 2,grade 3:16 cases,9 cases,2 cases,1 cases.Among all the 28 postoperative 3D-TOF MRA, we excluded 1 cases that have preoperative 3D-TOF MRA score of 0 and got 27 cases involved into calculation of relief rate of NVC.The relief rate of NVC showed group a, group β,group γ:18 cases、5 cases、4 cases.,All the surgical outcome was assessed 2 mouths-l years (average 6.1mouths) postoperatively.It showed the pain instantly disappea have 22 cases,4 cases pain relieved, taking carbamazepine can get control the pain,the effective rate is 92,86%.2 cases is still pain as same as before MVD. The significant difference can be found in different postoperative NVC groups and in different relief rate groups.Conclusion:Postoperative 3D-TOF MRA can help us predict the outcome of MVD; less severity of postoperative NVC and more relief of compression could be possible prognostic factors.