Girard N, Poncet M, Chays A, Florence A, Gignac D, Magnan J, Raybaud C
Service de Radiologie, Hôpital Nord, Marseille.
J Neuroradiol. 1993 Dec;20(4):226-38.
We report our experience of intrapetrous facial nerve evaluation in 33 patients examined by three-dimensional MRI (3D-FT) with intravenous gadolinium injection. The examinations were performed by a 1 Tesla magnet, using Flash and Turbo-Flash sequences which enabled us to obtain contiguous millimetric sections and to make reconstructions in all planes. Among these 33 patients, 31 had facial palsy and 2 a facial nerve lesion without clinical signs and discovered by chance. Facial palsy had started rather abruptly in 26 cases. It was either idiopathic (n = 20) or caused by herpes zoster (n = 1), injuries (n = 2), metastasis (n = 1) and tumour (n = 1); it was concomitant with a granuloma in 1 case. Five patients seen or explored late had congenital cholesteatoma (n = 2), facial nerve neurinoma (n = 2) or persistent idiopathic facial palsy (n = 1). There was no contrast enhancement in "chronic" non tumoral facial palsy. All tumours (neurinoma, neurofibroma, metastasis) were contrast-enhanced, as were the 2 cases of traumatic palsy and the case with granuloma of the labyrinth. In acute idiopathic facial palsy (n = 20), contrast enhancement was demonstrated in 11 patients; among these, recovery was complete at 2 months in 1 case and incomplete in 9 cases; 1 patient was lost sight of. In the 9 patients without contrast enhancement, recovery was complete in 7; 2 patients were lost sight of. This study shows that minute lesions of the facial nerve can be detected with millimetric MRI T1-weighted sequences and contrast enhancement. It also suggests that contrast enhancement has some prognostic value in patients with acute idiopathic facial palsy.
我们报告了33例接受静脉注射钆剂的三维磁共振成像（3D-FT）检查的患者的岩骨内面神经评估经验。检查使用1特斯拉磁体进行，采用快速成像序列（Flash）和快速自旋回波序列（Turbo-Flash），使我们能够获得连续的毫米层厚图像并进行多平面重建。在这33例患者中，31例有面神经麻痹，2例面神经病变但无临床症状，为偶然发现。26例面神经麻痹起病较突然。病因包括特发性（n = 20）、带状疱疹（n = 1）、损伤（n = 2）、转移瘤（n = 1）和肿瘤（n = 1）；1例伴有肉芽肿。5例晚期就诊或接受探查的患者患有先天性胆脂瘤（n = 2）、面神经神经鞘瘤（n = 2）或持续性特发性面神经麻痹（n = 1）。“慢性”非肿瘤性面神经麻痹无强化表现。所有肿瘤（神经鞘瘤、神经纤维瘤、转移瘤）均有强化，2例创伤性麻痹和1例迷路肉芽肿病例也有强化。在急性特发性面神经麻痹（n = 20）患者中，11例有强化表现；其中，1例在2个月时完全恢复，9例恢复不完全；1例失访。9例无强化表现的患者中，7例完全恢复；2例失访。本研究表明，利用毫米级MRI T1加权序列及强化可检测出面神经的微小病变。这也提示强化对急性特发性面神经麻痹患者有一定的预后价值。
