Miller Jonathan, Acar Feridun, Hamilton Bronwyn, Burchiel Kim
Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, USA.
J Neurosurg. 2008 Mar;108(3):477-82. doi: 10.3171/JNS/2008/108/3/0477.
The authors report on a novel technique to identify neurovascular compression in trigeminal neuralgia (TN). Using 3D reconstructed high-resolution balanced fast-field echo (BFFE) images fused with 3D time-of-flight (TOF) magnetic resonance (MR) angiography and Gd-enhanced 3D spoiled gradient recalled sequence, it is possible to objectively visualize the trigeminal nerve and nearby arteries and veins.
Magnetic resonance imaging was performed in 18 patients with unilateral TN using 3 sequences: BFFE, 3D TOF angiography, and 3D Gd-enhanced imaging. The images were imported into OsiriX imaging software; after their fusion, a 3D false-color reconstruction was produced using surface rendering. The reconstructed images objectively differentiate nerves and vessels and can be viewed from any angle, including the anticipated surgical approach.
Fifteen patients were predicted to have neurovascular compression on the symptomatic side (9 arterial and 6 venous compressions). All patients had a vascular structure that was identical in location and configuration to that predicted on preoperative analysis. The 3 patients without predicted compression underwent surgical exploration because they manifested the classic symptoms. As expected, exploration in 2 of these patients revealed no offending vessel. The third patient had a small vein embedded in the trigeminal nerve that was beyond the resolution of the 3D Gd-enhanced study.
Combining BFFE with MR angiography and Gd-enhanced MR images capitalizes on the advantages of both techniques, enabling MR angiography and contrast-enhanced MR imaging discrimination of vascular structures at BFFE resolution. This results in an unambiguous 3D image that can be used to identify the neurovascular compression and plan the surgical approach.
作者报告一种用于识别三叉神经痛（TN）中神经血管压迫的新技术。通过将三维重建的高分辨率平衡快速场回波（BFFE）图像与三维时间飞跃（TOF）磁共振（MR）血管造影及钆增强三维扰相梯度回波序列相融合，能够客观地显示三叉神经以及附近的动脉和静脉。
对18例单侧TN患者进行磁共振成像，采用3种序列：BFFE、三维TOF血管造影和三维钆增强成像。将图像导入OsiriX成像软件；融合后，使用表面渲染生成三维伪彩色重建图像。重建图像能客观地区分神经和血管，并且可以从任何角度查看，包括预期的手术入路角度。
15例患者被预测在症状侧存在神经血管压迫（9例动脉压迫和6例静脉压迫）。所有患者均有一个在位置和形态上与术前分析预测一致的血管结构。3例未被预测有压迫的患者因表现出典型症状而接受了手术探查。正如预期的那样，其中2例患者的探查未发现肇事血管。第3例患者有一条小静脉嵌入三叉神经，超出了三维钆增强研究的分辨率。
将BFFE与MR血管造影及钆增强MR图像相结合，利用了两种技术的优势，使MR血管造影和对比增强MR成像能够在BFFE分辨率下区分血管结构。这产生了一个清晰的三维图像，可用于识别神经血管压迫并规划手术入路。
