本文選題：三維時間飛躍法磁共振血管成像 + 微血管減壓術(shù)�。� 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：背景:隨著顯微鏡技術(shù)在外科手術(shù)中的廣泛使用,微血管減壓術(shù)由于其安全有效得以迅速在臨床上推廣。近年來,在原發(fā)性面肌痙攣及原發(fā)性三叉神經(jīng)痛的治療中微血管減壓術(shù)取得了良好的療效,由于微血管減壓術(shù)能夠更完善地保留神經(jīng)功能,其治愈率較高,復(fù)發(fā)率較低,臨床效果肯定,微血管減壓術(shù)已成為國內(nèi)外均認(rèn)可的治療原發(fā)性面肌痙攣及原發(fā)性三叉神經(jīng)痛的首選方法。三維時間飛躍法磁共振血管成像是一種全新的無創(chuàng)性血管成像方法,利用核磁共振成像技術(shù)對橋小腦角區(qū)的血管及神經(jīng)路徑進(jìn)行掃描,能夠顯示橋小腦角區(qū)血管與神經(jīng)的三維空間關(guān)系。本研究通過回顧性分析,進(jìn)一步研討三維時間飛躍法磁共振血管成像對微血管減壓術(shù)治療原發(fā)性面肌痙攣及原發(fā)性三叉神經(jīng)痛的臨床指導(dǎo)意義。目的:觀察三維時間飛躍法磁共振血管成像(3D-TOF-MRA)對橋小腦角區(qū)血管與神經(jīng)三維空間關(guān)系的顯示,與微血管減壓術(shù)(MVD)中所見的血管與神經(jīng)三維空間關(guān)系進(jìn)行對比,探討3D-TOF-MRA對微血管減壓術(shù)的臨床指導(dǎo)意義。方法:回顧性分析36例自2016年6月~2017年2月于吉林大學(xué)第二醫(yī)院神經(jīng)外一科行MVD治療原發(fā)性面肌痙攣(HFS)及原發(fā)性三叉神經(jīng)痛(TN)的患者的臨床資料。術(shù)前均給予患者行3D-TOF-MRA檢查,通過3D-TOF-MRA判定壓迫神經(jīng)的責(zé)任血管,并與MVD術(shù)中所見的實際情況進(jìn)行比較。結(jié)果:本組36例患者中有33例患者于術(shù)前行3D-TOF-MRA檢查后發(fā)現(xiàn)有明顯的責(zé)任血管壓迫面神經(jīng)或三叉神經(jīng),其中責(zé)任血管為小腦前下動脈12例、小腦后下動脈11例、小腦前下動脈聯(lián)合椎動脈5例、小腦上動脈5例;其中有31例在MVD術(shù)中證實有相同的血管壓迫神經(jīng)情況。有3例患者術(shù)前行3D-TOF-MRA檢查后未發(fā)現(xiàn)有明顯的責(zé)任血管,術(shù)中證實為小腦前下動脈、小腦后下動脈和小腦上動脈的較細(xì)分支壓迫面神經(jīng)或三叉神經(jīng)。有2例TN患者行3D-TOF-MRA檢查所示小腦上動脈壓迫三叉神經(jīng),而術(shù)中所見為小腦上動脈聯(lián)合靜脈壓迫三叉神經(jīng)。本組資料中3D-TOF-MRA與術(shù)中結(jié)果在責(zé)任血管的判定上比較,經(jīng)統(tǒng)計學(xué)分析,差異無統(tǒng)計學(xué)意義(P0.05)。使用術(shù)中結(jié)果診斷原發(fā)性面肌痙攣及原發(fā)性三叉神經(jīng)痛患者的陽性率為100%(36/36)。應(yīng)用3D-TOF-MRA診斷原發(fā)性面肌痙攣及原發(fā)性三叉神經(jīng)痛患者的陽性率為91.67%(33/36)。經(jīng)統(tǒng)計學(xué)分析,3D-TOF-MRA與術(shù)中責(zé)任血管檢測結(jié)果對原發(fā)性面肌痙攣和原發(fā)性三叉神經(jīng)痛的診斷具有高度的一致性(K=0.92)。結(jié)論:3D-TOF-MRA能夠清晰地顯示橋小腦角區(qū)血管和神經(jīng)的三維空間關(guān)系,可作為診斷原發(fā)性面肌痙攣及原發(fā)性三叉神經(jīng)痛的方法之一。術(shù)前進(jìn)行3D-TOF-MRA檢查,可以明確HFS與TN的病因,初步判定責(zé)任血管,指導(dǎo)MVD手術(shù)操作,提高手術(shù)質(zhì)量,確保手術(shù)療效。
[Abstract]:Background: microvascular decompression has been widely used in surgery due to its safety and efficacy. In recent years, microvascular decompression has achieved good results in the treatment of primary hemifacial spasm and trigeminal neuralgia. Microvascular decompression has become the first choice in the treatment of primary hemifacial spasm and trigeminal neuralgia. Magnetic resonance angiography (MRA) is a novel and noninvasive imaging method. Magnetic resonance imaging (MRI) is used to scan the vessels and nerve pathways in the cerebellopontine angle area. It can show the three-dimensional spatial relationship between the vessels and nerves in the cerebellopontine angle area. The purpose of this study was to study the clinical significance of three dimensional time leap magnetic resonance angiography (MRA) in the treatment of primary facial spasm and trigeminal neuralgia by microvascular decompression in the treatment of primary hemifacial spasm and trigeminal neuralgia. Objective: to observe the display of three-dimensional spatial relationship between the vessels and nerves in the cerebellopontine angle area by 3D-TOF-MRA-3D-TOF-MRAA, and to compare it with the three-dimensional spatial relationship between the vessels and nerves in microvascular decompression. To explore the clinical significance of 3D-TOF-MRA in microvascular decompression. Methods: the clinical data of 36 patients with primary hemifacial spasm and primary trigeminal neuralgia treated with MVD from June 2016 to February 2017 in the Department of Neurology, second Hospital of Jilin University were retrospectively analyzed. Patients were examined with 3D-TOF-MRA before operation, and the responsible vessels of nerve compression were judged by 3D-TOF-MRA, and compared with the actual situation during MVD. Results: 33 of the 36 patients underwent 3D-TOF-MRA examination before operation and found that there were obvious responsible vessels pressing facial nerve or trigeminal nerve. The responsible vessels were anterior inferior cerebellar artery in 12 cases, posterior inferior cerebellar artery in 11 cases, and anterior inferior cerebellar artery in 12 cases, and posterior inferior cerebellar artery in 11 cases. There were 5 cases of anterior inferior cerebellar artery combined with vertebral artery and 5 cases of superior cerebellar artery, among which 31 cases were confirmed to have the same vascular compression during MVD. In 3 cases, there were no obvious responsible vessels after 3D-TOF-MRA examination before operation. It was proved to be a fine branch of the anterior inferior cerebellar artery, posterior inferior cerebellar artery and superior cerebellar artery to compress the facial nerve or trigeminal nerve. In 2 patients with TN, the superior cerebellar artery compressed the trigeminal nerve, and the superior cerebellar artery combined with the vein compressed the trigeminal nerve. In this group, 3D-TOF-MRA was compared with operative results in the judgment of responsible vessels. There was no significant difference between 3D-TOF-MRA and operative results (P 0.05). The positive rate of intraoperative diagnosis of primary hemifacial spasm and trigeminal neuralgia was 100 / 36 / 36. The positive rate of 3D-TOF-MRA in the diagnosis of primary hemifacial spasm and trigeminal neuralgia was 91.67 / 36. The results of statistical analysis of 3D-TOF-MRA and intraoperative responsible vascular examination were highly consistent in the diagnosis of primary hemifacial spasm and primary trigeminal neuralgia. Conclusion the three dimensional spatial relationship of the vessels and nerves in cerebellopontine angle area can be clearly demonstrated by the 3 D TOF MRA, which can be used as one of the methods for the diagnosis of primary hemifacial spasm and trigeminal neuralgia. 3D-TOF-MRA examination before operation can determine the etiology of HFS and TN, determine the responsible blood vessels, guide the operation of MVD, improve the quality of operation and ensure the curative effect.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R651.3

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