The Clinical Directive Significance Of 3D-TOF-MRA In Microvascular Decompression

Background:With the extensive use of microscopy in surgical surgery,microvascular decompression is rapidly and clinically promoted due to its safety and effectiveness.In recent years,microvascular decompression achieved good curative effect in the treatment of primary hemifacial spasm and primary trigeminal neuralgia.As a result of microvascular decompression can be better used to retain nerve function and has higher cure rate,lower recurrence,microvascular decompression which have certain clinical effect has become recognized as the preferred method around the world.3D-Time Of Flight-Magnetic Resonance Angiography is a new noninvasive method of angiography.The use of nuclear magnetic resonance imaging technique to scan the blood vessels and nerve pathways of the cerebellopontine angle can show the three-dimensional relationship between the vessels and nerves of the cerebellopontine angle.In this study,we retrospectively analyzed the clinical significance of 3D-Time Of Flight-Magnetic Resonance Angiography in the treatment of primary hemifacial spasm and primary trigeminal neuralgia by microvascular decompression.Objective:To observe the three-dimensional space relationship between vascular and nerve in cerebellopontine angle using 3D-Time Of Flight-Magnetic Resonance Angiography(3D-TOF-MRA),compare with what we saw during surgery of microvascular decompression(MVD).To explore the clinical significance of3D-TOF-MRA in microvascular decompression.Method:Retrospectively analyze the clinical data of 36 patients with primary hemifacial spasm(HFS)and primary trigeminal neuralgia(TN)who were treated with MVDfrom June 2016 to February 2017 at the Second Hospital of Jilin University.The3D-TOF-MRA was performed by the patients before surgery.The responsible blood vessels of the oppressive nerve were determined by 3D-TOF-MRA and compared with the operative findings in MVD.Result:In this group of 36 patients,33 patients underwent 3D-TOF-MRA examination showed significant responsibility for vascular compression of the facial nerve or trigeminal nerve,which accounted for 12 cases of anterior inferior cerebellar artery,11 cases of posterior inferior cerebellar artery,5 cases of anterior inferior cerebellar arteries and vertebral artery,5 cases of superior cerebellar artery;Among these patients we confirmed the same vascular compression in MVD for 31 patients.Three patients underwent 3D-TOF-MRA examination without significant blood vessels,confirmed a smaller branch of the anterior inferior cerebellar artery 、 the posterior inferior cerebellar artery and the superior cerebellar artery oppressing the facial nerve or the tregeminal nerve during surgery.2 cases of TN patients with 3D-TOF-MRA examination showed superior cerebellar artery compression of the trigeminal nerve,but confirmed the superior cerebellar artery combined with the veins oppressing trigeminal nerve during surgery.In this group of data,the difference between using3D-TOF-MRA to determine the responsible blood vessels and using operative findings to determine the responsible blood vessels was not statistically significant through statistical analysis(P>0.05).The positive rate in using operative findings to diagnose primary hemifacial spasm and primary trigeminal neuralgia was 100%(36/36).The positive rate in using 3D-TOF-MRA to diagnose primary hemifacial spasm and primary trigeminal neuralgia was 91.67%(33/36).Through statistical analysis,there was a high degree of consistency in the diagnosis of primary hemifacial spasm and primary trigeminal neuralgia using 3D-TOF-MRA compared with operative findings(K = 0.92).Conclusion:3D-TOF-MRA can clearly show the three-dimensional spatial relationshipbetween blood vessels and nerves in cerebellopontine angle,which can be used as one of the methods to diagnose primary hemifacial spasm and primary trigeminal neuralgia.Preoperative 3D-TOF-MRA examination can clear the cause of HFS and TN,initially determine the responsibility of blood vessels,guide MVD operation,improve the quality of surgery to ensure the efficacy of surgery.