Department of Neurosurgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
J Neuroimaging. 2010 Oct;20(4):345-9. doi: 10.1111/j.1552-6569.2009.00378.x.
To investigate the role of preoperative magnetic resonance tomographic angiography (MRTA) in predicting the clinical outcomes of trigeminal neuralgia (TN) patients following microvascular decompression (MVD).
Preoperative MRTA imaging was performed on 167 consecutive patients with TN. The characteristics of offending vessels were determined by MRTA prior to MVD. The relationship of neurovascular contact was classified into 3 types: positive, negative, and contralateral positive, which were compared with the surgical findings and clinical outcomes.
MRTA showed obvious neurovascular compression in accordance with surgical findings in 144 patients. Among the remaining 23 patients with negative finding on preoperative MRTA images, neurovascular compression (vein alone or in combination with artery) were found in 16, no definite vascular compression in 7. The sensitivity of MRTA on the symptomatic side was therefore 90%, the specificity was 100% in our series. A correlation was found between clinical outcomes and preoperative findings on MRTA. In 144 MRTA-positive patients, 136 achieved "excellent" or "good" outcomes after MVD and were significantly better than the MRTA-negative group (P < .01). The outcomes of patients with a single artery compression were significantly better than those with venous compression, vein in combination with artery compression, or without obvious neurovascular contact (P < .01). Seven of 23 MRTA-negative patients obtained poor outcomes after operation, venous compression were identified intraoperatively in 4 of them, no definite offending vessel was found in 3 patients.
This study suggests that the curative rate of TN following MVD is higher in the MRTA-positive group. Venous compression and no neurovascular contact that were negative on MRTA image are poor prognostic factors for surgical outcome of TN. Thus, preoperative MRTA serves as a useful tool in patient selection and outcome prediction.
探讨术前磁共振血管成像（MRTA）在预测微血管减压术（MVD）后三叉神经痛（TN）患者临床疗效中的作用。
对 167 例连续 TN 患者进行术前 MRTA 成像。在 MVD 前，通过 MRTA 确定致病血管的特征。将神经血管接触关系分为 3 型：阳性、阴性和对侧阳性，并与手术发现和临床结果进行比较。
MRTA 在 144 例患者中与手术发现一致，显示明显的神经血管压迫。在术前 MRTA 图像为阴性的其余 23 例患者中，16 例发现神经血管压迫（单纯静脉或静脉与动脉结合），7 例无明确血管压迫。因此，MRTA 在症状侧的灵敏度为 90%，特异性为 100%。MRTA 的术前发现与临床结果相关。在 144 例 MRTA 阳性患者中，136 例在 MVD 后获得“良好”或“优”的疗效，明显优于 MRTA 阴性组（P <.01）。动脉压迫患者的疗效明显优于静脉压迫、静脉与动脉联合压迫或无明显神经血管接触的患者（P <.01）。23 例 MRTA 阴性患者中有 7 例术后疗效不佳，其中 4 例术中发现静脉压迫，3 例无明确致病血管。
本研究表明，MVD 后 TN 的治愈率在 MRTA 阳性组更高。MRTA 图像阴性的静脉压迫和无神经血管接触是 TN 手术预后不良的预测因素。因此，术前 MRTA 是一种有用的患者选择和预后预测工具。
