| Background and ObjectiveVertigo is one of the most common causes of neurology outpatient with thepopulation incidence rate of10%, while patients with vestibular paroxysmia(VP)accounted for about3.9%incidence of dizziness and vertigo outpatients. Currentlypeople still lack a deep understanding of the disease. The repeated episodes of vertigowas the main performance of VP, often accompanied by tinnitus, hearing loss,unsteady gait, nausea, vomiting and other symptoms, seriously affecting people’swork and life, and ineffectively reacting for the general treatment of vertigo drugs.Currently, scholars generally believe that the pathogenesis of the disease is similarwith trigeminal neuralgia, caused by vascular compression of the vestibular cochlearnerve. The disease is effective for the antiepileptic drugs such as carbamazepinewhich can significantly reduce the times and duration and alleviate severity ofdizziness and vertigo, Patients who cannot tolerate poor or adverse drug reactionsalways have a good effect for microvascular decompression.Diagnosis of the disease still lacks of specific diagnostic methods. However, inrecent years the magnetic field strength of MRI continues to improve, thehigh-resolution magnetic resonance imaging techniques are rapidly developing, andthe post-processing operating system is constantly being improved, all these maketiny structures in posterior fossa clearly show as possible, which not only provides an important method for the diagnosis of the disease, but also for the surgical treatmentof a guiding role. In this study, based on three-dimensional MRI imaging techniquesto analyze the frequency and type of neurovascular compression, the origin of theoffending vessel in patients with VP. As for vascular compression mechanism, therole of the site of vascular compression in the occurrence of VP has beencontroversial, the study using imaging methods to explore the issue.Methods28cases of VP (VP group) and28cases of other vertiginous patients (controlgroup) who underwent MRI were retrospectively collected. Three dimensional-timeof flight-MR angiography (3D-TOF-MRA) was used for NVCC interpretation. Thefrequency and type of neurovascular cross-compression (NVCC), the origin of theoffending vessel and the distance between compression site and brainstem werecompared between the two groups.ResultsThe frequency of NVCC was96.4%in VP group, there was a significantdifference compared with control group (46.4%)(χ2=17.15, P<0.001). The mostcommon NVCC type was vascular loop compression at vestibulocochlear nerve（42.9%）, anterior inferior cerebellar artery was the most common offending vessel（71.4%）in VP group, there were no significant differences between the two groupsin the type of NVCC or the origin of the offending vessel (P>0.05). The frequency onthe distortion and/or displacement of vestibulocochlear nerve which was severelycompressed by vessel in VP group (12.5%) was significantly higher than controlgroup (0)(P=0.013, P<0.05). The distance between compression site and brainstemwas (8.57±5.08) mm in VP group, in control was (8.93±4.64) mm. These data did notdemonstrate a significant difference (P>0.05). The ratio that the distance was lessthan15mm between compression site and brainstem in unilateral NVCC of VP group(100%) was significantly higher than unilateral NVCC of control group(70%)(P=0.033, P<0.05).Conclusions1. Patients with VP have a relatively higher incidence of NVCC.2. The most common NVCC type is vascular loop compression at vestibulocochlear nerve which is mainly caused by anterior inferior cerebellar artery.NVCC of VP patients tends to occur in the central portion of vestibulocochlear nerve.3. Vascular compression of the central vestibular cochlear nerve and severevascular compression may be associated with the onset of VP.4.3D-TOF-MRA sequences can be clearly displayed the relationship betweenvestibulocochlear nerve and blood vessels in posterior fossa, particularly thediscovery of arterial compression, and have obvious advantages to determine the typeand vascular origin of arterial compression. |
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