Patel N K, Aquilina K, Clarke Y, Renowden S A, Coakham H B
Department of Neurosurgery, Frenchay Hospital, Bristol, UK.
Br J Neurosurg. 2003 Feb;17(1):60-4.
Ninety-two patients with trigeminal neuralgia (TGN) were investigated prior to posterior fossa surgery with magnetic resonance imaging (MRI) and contrast-enhanced magnetic resonance angiography (MRA). The preoperative investigation was matched to one consultant neuroradiologist (co-author) who was blinded to the side of symptomotology. The imaging results were compared with the operative findings in all patients. In 76 patients MRA showed present neurovascular compression in accordance with surgical findings. Eight cases had no compression either on MRA or intraoperatively. Eight predictions of no compression were false and there was no false positive. Based on surgical findings, the sensitivity of MRA was 90.5% and the specificity 100%. In 19 cases MRA predicted bilateral compression of the trigeminal nerves. Only two cases had clinically bilateral TGN. We conclude that MRA with gadolinium enhancement is an extremely sensitive and specific method for demonstrating compression in TGN. As a result posterior fossa surgery can be recommended with confidence, and microvascular decompression remains the treatment of choice for TGN at the authors' centre.
92例三叉神经痛（TGN）患者在进行后颅窝手术前接受了磁共振成像（MRI）和对比增强磁共振血管造影（MRA）检查。术前检查由一位对症状侧不知情的神经放射科顾问医生（共同作者）进行。将所有患者的影像学结果与手术结果进行比较。76例患者的MRA显示存在与手术结果一致的神经血管压迫。8例患者在MRA或术中均未发现压迫。8例预测无压迫的结果为假阴性，且无假阳性。根据手术结果，MRA的敏感性为90.5%，特异性为100%。19例患者的MRA预测为双侧三叉神经受压。仅有2例患者临床上为双侧TGN。我们得出结论，钆增强MRA是一种用于显示TGN中压迫的极其敏感和特异的方法。因此，可以放心地推荐后颅窝手术，在作者所在中心，微血管减压仍然是TGN的首选治疗方法。
