Kuncz A, Vörös E, Barzó P, Tajti J, Milassin P, Mucsi Z, Elek P, Benedek K, Tarjányi J, Bodosi M
Department of Neurosurgery, Faculty of Medicine, University of Szeged, Szeged, Hungary.
Cephalalgia. 2006 Mar;26(3):266-76. doi: 10.1111/j.1468-2982.2005.01030.x.
Neurovascular compression (NC) seems to have been confirmed as the major cause of classical trigeminal neuralgia (TN). In spite of the large number of surgically positive cases, however, there are still cases where no vascular compression of the trigeminal nerve can be found. To evaluate whether NC could be demonstrated preoperatively, high-resolution magnetic resonance angiography (MRA) was performed in 287 consecutive patients with TN and persistent idiopathic facial pain (PIFP) on a 0.5-T and a 1-T MR unit. Depending on the clinical symptoms, the TN cases were divided into typical TN and trigeminal neuralgia with non-neuralgic interparoxysmal pain (TNWIP) groups. Microvascular decompression (MVD) was performed in 103 of the MRA-positive cases. The patients were followed up postoperatively for from 1 to 10 years. The clinical symptoms were compared with the imaging results. The value of MRA was assessed on the basis of the clinical symptoms and surgical findings. The outcome of MVD was graded as excellent, good or poor. The clinical symptoms were compared with the type of vascular compression and the outcome of MVD. The MRA image was positive in 161 (56%) of the 287 cases. There were significant differences between the clinical groups: 66.5% of the typical TN group, 47.5% of the TNWIP group and 3.4% of the PIFP group were positive. The quality of the MR unit significantly determined the ratio of positive/negative MRA results. The surgical findings corresponded with the MRA images. Six patients from the MRA-negative group were operated on for selective rhizotomy and no NC was found. Venous compression of the trigeminal nerve was observed in a significantly higher proportion in the background of TNWIP than in that of typical TN on MRA imaging (24.1% and 0.8%, respectively) and also during MVD (31.2% and 1.2%, respectively). Four years following the MVD, 69% of the patients gave an excellent, 23% a good and 8% a poor result. The rate of some kind of recurrence of pain was 20% in the typical TN and 44% in TNWIP group. The rate of recurrence was 57% when pure venous compression was present. The only patient who was operated on from the PIFP group did not react to the MVD. The clinical symptoms and preoperative MRA performed by at least a 1-T MR unit furnish considerable information, which can play a role in the planning of the treatment of TN.
神经血管压迫（NC）似乎已被确认为经典三叉神经痛（TN）的主要病因。然而，尽管手术阳性病例数量众多，但仍有一些病例未发现三叉神经的血管压迫。为了评估术前是否能显示出NC，对287例连续的TN和持续性特发性面部疼痛（PIFP）患者在0.5-T和1-T磁共振单元上进行了高分辨率磁共振血管造影（MRA）。根据临床症状，将TN病例分为典型TN和伴有非神经痛性发作间期疼痛的三叉神经痛（TNWIP）组。对103例MRA阳性病例进行了微血管减压术（MVD）。对患者进行了1至10年的术后随访。将临床症状与影像学结果进行了比较。根据临床症状和手术结果评估了MRA的价值。将MVD的结果分为优、良或差。将临床症状与血管压迫类型和MVD结果进行了比较。287例病例中，161例（56%）的MRA图像呈阳性。临床组之间存在显著差异：典型TN组为66.5%，TNWIP组为47.5%，PIFP组为3.4%呈阳性。磁共振单元的质量显著决定了MRA阳性/阴性结果的比例。手术结果与MRA图像相符。对MRA阴性组的6例患者进行了选择性神经根切断术，未发现NC。在MRA成像中，TNWIP背景下观察到三叉神经静脉压迫的比例明显高于典型TN背景下（分别为24.1%和0.8%），在MVD期间也是如此（分别为31.2%和1.2%）。MVD术后四年，69%的患者结果为优，23%为良，8%为差。典型TN组疼痛某种程度复发率为20%，TNWIP组为44%。存在单纯静脉压迫时复发率为57%。PIFP组唯一接受手术的患者对MVD无反应。由至少1-T磁共振单元进行的临床症状和术前MRA提供了相当多的信息，这在TN治疗方案的规划中可以发挥作用。
