Correlation Between MR 3D-TOF Sequence Imaging And Curative Effect Of Microvascular Decompression In Patients With Primary Trigeminal Neuralgia

[Objective]:Based on the imaging characteristics of trigeminal nerve magnetic resonance,this study used three dimensional time-of-flight(3D-TOF)sequence to study the relationship between cisternal segment of trigeminal nerve and peripheral blood vessels in patients with primary trigeminal neuralgia(ITN)and microvascu decompression.Compared with the origin and quantity of the responsible vessels observed during MVD,the coincidence of the two vessels and their relationship with the curative effect were analyzed.[Mathods]:The data of 103 patients(41 males,62 females,aged 42-79 years)who underwent MVD surgery were retrospectively analyzed.All patients were excluded from intracranial diseases according to typical clinical complaints before operation The patients were diagnosed as primary trigeminal neuralgia by conventional magnetic resonance sequence scanning,and then underwent 3D-TOF sequence examination.The neurosurgeons and radiologists read together to analyze the direction and relationship of blood vessels and nerves,and to identify the responsible blood vessels and the number of them.Video recording of the whole micromanipulation process was performed during MVD.The types of responsible vessels confirmed during MVD were compared.Preoperative MR 3D-TOF sequence display was combined with follow-up data to determine the degree of coincidence with the number of sources of responsible vessels seen during operation and the relationship with prognosis[Results]:Among 103 patients,89 patients had complete preoperative 3D-TOF coincidence with intraoperative findings,11 patients had partial preoperative 3D-TOF coincidence with intraoperative findings,and 3 patients had no preoperative 3D-TOF coincidence with intraoperative findings,the coincidence rate was 97.1%.The degree of anastomosis of arteries solely responsible for vessels is higher than that of venous vessels.The effective rate of MVD for primary trigeminal neuralgia was 90.3%.89 patients in complete anastomosis group,11 patients in partial anastomosis group and 3 patients in non-anastomosis group were treated with Spearman grade correlation test combined with the follow-up results,P<0.01.The follow-up results in complete anastomosis group were better than those in partial anastomosis group and non-anastomosis group.The most common responsible vessels were superior cerebellar artery in 73 cases,inferior anterior cerebellar artery in 14 cases,petrous vein in 8 cases,arteriovenous mixture in 5 cases and non-vascular factors in 3 cases.103 patients were divided into superior cerebellar artery group,inferior anterior cerebellar artery group and other groups.Combined with the follow-up results of three groups,the rank sum test of multiple groups was used,P<0.01.Two comparisons showed that the curative effect of superior cerebellar artery group and anterior inferior cerebellar artery group was better than that of other groups[Conclusion]:Preoperative MR 3D-TOF confirmed the high coincidence rate between the responsible vessels and intraoperative exploration results,which can enable surgeons to objectively understand the number,compression site and source of the responsible vessels before surgery,help to reproduce the spatial structure of local anatomy,and provide important reference for surgical planning.The degree of anastomosis of arteries solely responsible for vessels is higher than that of venous vessels.The results of complete anastomosis group were better than those of partial anastomosis group and non anastomosis group.The most common vessel responsible for trigeminal neuralgia is the superior cerebellar artery,followed by the inferior cerebellar artery.The effect of venous involvement in responsible vessels is inferior to that of simple responsible arteries.