Magnaldi S, Cecconi P, Skrap M, Ricci C, Cova M A, Pozzi-Mucelli R S
Istituto di Radiologia, Università, Trieste.
Radiol Med. 1992 Jun;83(6):700-5.
One of the possible causes of the so-called "essential" trigeminal neuralgia is a neurovascular compression of the fifth cranial nerve root at the pons. The demonstration of this hypothesis could orientate the surgical treatment to microvascular decompression. In order to evaluate the role of MRI in the diagnosis of trigeminal neuralgia due to neurovascular compression, the authors present the results of a prospective evaluation of the cranial MR studies of 18 neuralgic patients in comparison with a retrospective evaluation of the cranial MR studies of 50 healthy control subjects. The results show that neurovascular compression can be demonstrated in 83.3% of the neurological patients. In all cases a good correlation between the clinical symptoms, the side of positive MR findings and the surgical findings, when available, was demonstrated. On the other hand, neurovascular compression was demonstrated in 28% of the healthy control subjects. The authors conclude that neurovascular compression can be demonstrated in a high percentage of patients with the so-called "essential" trigeminal neuralgia. Compared with the other imaging modalities (angiography, Computed Tomography) MRI is the best technique in the diagnosis of this disease. In fact, MRI is not only able to differentiate the symptomatic from the essential type of neuralgia, but is also very sensitive in the identification of trigeminal neuralgia due to neurovascular compression. This diagnosis could direct the surgical treatment to microvascular decompression.
所谓“原发性”三叉神经痛的可能病因之一是脑桥处第五颅神经根的神经血管受压。这一假说的证实可为手术治疗导向微血管减压术。为评估磁共振成像（MRI）在诊断神经血管受压所致三叉神经痛中的作用，作者呈现了对18例神经痛患者头颅MR研究的前瞻性评估结果，并与对50例健康对照者头颅MR研究的回顾性评估结果进行比较。结果显示，83.3%的神经科患者可证实存在神经血管受压。在所有病例中，均证实临床症状、MR阳性发现的一侧与手术发现（若有）之间存在良好相关性。另一方面，28%的健康对照者证实存在神经血管受压。作者得出结论，在所谓“原发性”三叉神经痛患者中，高比例患者可证实存在神经血管受压。与其他成像方式（血管造影、计算机断层扫描）相比，MRI是诊断该病的最佳技术。事实上，MRI不仅能够区分症状性神经痛与原发性神经痛类型，而且在识别神经血管受压所致三叉神经痛方面也非常敏感。这一诊断可为手术治疗导向微血管减压术。
