Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Department of ENT, Guy's and St Thomas' NHS Foundation Trust, London, UK.
J Vestib Res. 2019;29(2-3):137-145. doi: 10.3233/VES-190661.
BACKGROUND/OBJECTIVES: Vestibular paroxysmia (VP) presents as episodic vertigo believed to be caused by neurovascular cross-compression (NVCC) of the vestibulocochlear nerve. We investigated whether NVCC occurred at a higher rate in VP, compared with controls and whether angulation of the nerve, the vessel involved and location of the point of contact were significant features.
Retrospective analysis was conducted of MR imaging performed in patients with VP and also patients with unilateral tinnitus (in whom the asymptomatic side was used as a control). Two independent, blinded reviewers assessed each case.
Nine patients with VP and 20 patients with unilateral tinnitus were included. NVCC was demonstrated in all 9 VP patients (100%), compared with 9 of the controls (45%), p = 0.0049. NVCC was mostly caused by a branch of the anterior inferior cerebellar artery (AICA). Nerve angulation at the point of contact occurred in 5 of the cases (44%), but in none of the controls (specificity = 100%), p = 0.0053. There was no correlation between site of contact and VP.
Our study supports the concept of NVCC in VP and additionally suggests that nerve angulation may be a specific feature. Neurovascular contact remains a common phenomenon in asymptomatic patients and therefore correlation with neuro-otology assessment remains essential.
背景/目的：前庭阵发性疾病（VP）表现为阵发性眩晕，据信是由前庭耳蜗神经的神经血管交叉压迫（NVCC）引起的。我们研究了与对照组相比，VP 中 NVCC 的发生率是否更高，以及神经、涉及的血管和接触点的角度是否为显著特征。
对 VP 患者和单侧耳鸣患者（其中无症状侧用作对照）进行回顾性分析。两位独立的、盲法的审查员评估了每个病例。
共纳入 9 例 VP 患者和 20 例单侧耳鸣患者。9 例 VP 患者均显示存在 NVCC（100%），而对照组中仅 9 例（45%）存在 NVCC，p=0.0049。NVCC 主要由小脑前下动脉（AICA）的分支引起。接触点处神经的角度在 5 例（44%）中发生，但在对照组中无一例发生（特异性=100%），p=0.0053。接触部位与 VP 之间无相关性。
我们的研究支持 VP 中存在 NVCC 的概念，并进一步表明神经角度可能是一个特定特征。神经血管接触在无症状患者中仍然是一种常见现象，因此与神经耳科学评估的相关性仍然至关重要。
