Chung S S, Chang J W, Kim S H, Chang J H, Park Y G, Kim D I
Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.
Acta Neurochir (Wien). 2000;142(8):901-6; discussion 907. doi: 10.1007/s007010070076.
The objective of this study was to investigate the role of preoperative three dimensional short-range magnetic resonance angiography (3D-TOF MRA) in predicting the clinical outcomes following microvascular decompression for the treatment of hemifacial spasm.
Preoperative magnetic resonance (MR) imaging was performed on all patients with hemifacial spasm (564 cases) between January 1992 and September 1998. Of the 564 patients, 440 patients were included in this retrospective study. The presence of vascular contact, offenders, and anomalies in the vertebro-basilar system, were determined by 3D-TOF MRA prior to microvascular decompression of the facial nerve. The preoperative findings were compared with the surgical findings and clinical outcomes. Findings. A correlation was found between the clinical outcome (p < 0.01) and the presence of a vascular indentation at the root entry zone (REZ) of the facial nerve. A shift of the vertebrobasilar system to the symptomatic side was found in 214 (48.6%) patients with hemifacial spasm, compared to only 10 (13.5%) patients in the control group (p < 0.01). The unilateral vertebral artery was observed in 43 (9.8%) patients with hemifacial spasm and in 8 (10.8%) of the control patients. A hypoplasia of the artery was found in 8 (1.8%) patients with hemifacial spasm and in 1 (1.4%) control patient. The compressing offenders in the patients, discovered by MRI in conjunction with MRA, were as follows: 45.9% (202 patients) in the anterior inferior cerebellar artery (AICA), 34.8% (153 patients) in the posterior inferior cerebellar artery (PICA), 12.5% (55 patients) in the vertebral artery (VA) and 6.8% (30 patients) in multiple vessels. In contrast to the compressing offenders seen on the MRA, the offenders confirmed during surgery were as follows: 43% (189 patients) in the AICA, 36.4% (160 patients) in the PICA, 1.4% (6 patients) in the VA, 19% (84 patients) in multiple vessels, and 0.2% (1 patient) in the vein. In our long-term follow-up series of the 440 patients with hemifacial spasm, an excellent surgical outcome was obtained in 86.3% of cases and a good outcome was achieved in 6.4% (mean follow-up duration, 45.5 months).
Preoperative 3D-TOF MRA can identify the relationship between the facial nerve and adjacent vessels in patients with a hemifacial spasm and assist in preoperative planning. This study suggests that 3D-TOF MRA is useful for selecting appropriate patients for surgical treatment and, to some extent, as an additional role for predicting the clinical outcome.
本研究的目的是探讨术前三维短程磁共振血管造影（3D-TOF MRA）在预测微血管减压治疗面肌痉挛临床疗效中的作用。
对1992年1月至1998年9月期间所有面肌痉挛患者（564例）进行术前磁共振成像（MR）检查。在这564例患者中，440例患者纳入本回顾性研究。在面神经微血管减压术前，通过3D-TOF MRA确定椎基底系统中血管接触、压迫血管及血管异常情况。将术前检查结果与手术结果及临床疗效进行比较。结果：临床疗效（p<0.01）与面神经根部入口区（REZ）血管压迹的存在之间存在相关性。214例（48.6%）面肌痉挛患者发现椎基底系统向症状侧移位，而对照组仅10例（13.5%）患者出现这种情况（p<0.01）。43例（9.8%）面肌痉挛患者观察到单侧椎动脉，对照组有8例（10.8%）。8例（1.8%）面肌痉挛患者和1例（1.4%）对照患者发现动脉发育不全。通过MRI联合MRA在患者中发现的压迫血管如下：小脑前下动脉（AICA）占比45.9%（202例），小脑后下动脉（PICA）占比34.8%（153例），椎动脉（VA）占比12.5%（55例），多支血管占比6.8%（30例）。与MRA上所见的压迫血管相比，手术中确认的压迫血管如下：AICA占比43%（189例），PICA占比36.4%（160例），VA占比1.4%（6例），多支血管占比19%（84例），静脉占比0.2%（1例）。在我们对440例面肌痉挛患者的长期随访系列中，86.3%的病例获得了优异的手术效果，6.4%的病例获得了良好的效果（平均随访时间为45.5个月）。
术前3D-TOF MRA可识别面肌痉挛患者面神经与相邻血管之间的关系，并有助于术前规划。本研究表明，3D-TOF MRA有助于选择合适的手术治疗患者，并且在一定程度上可作为预测临床疗效的辅助手段。
