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目的探讨内听道3D-磁共振成像(MRI)薄层扫描后颅窝内相关解剖学指标与原发性三叉神经痛(PTN)发病及行微血管减压术(MVD)治疗预后的关系。方法选择2013年3月—2015年3月新疆医科大学第一附属医院神经外科收治的符合纳入与排除标准的PTN患者63例为病例组,同时匹配性别、年龄、民族收集同时期本院体检中心自愿接受MRI检查的体检健康者20例为对照组,术前均行颅脑MRI平扫及内听道3D-MRI薄层扫描,观察后颅窝内桥小脑角(CPA)容积、三叉神经根体积、三叉神经根横截面积、三叉神经根长度等相关解剖学指标,PTN患者均行MVD治疗,根据预后分为有效组50例和无效组13例,分析一般资料及后颅窝内相关解剖学指标与MVD治疗预后的关系。结果对照组受试者左侧与右侧CPA容积、三叉神经根体积、三叉神经根横截面积、三叉神经根长度比较,差异均无统计学意义(P>0.05)。PTN患者患侧CPA容积、三叉神经根体积、三叉神经根横截面积小于健侧(P<0.05);健侧与患侧三叉神经根长度比较,差异无统计学意义(P>0.05)。有效组与无效组PTN患者性别、年龄、民族、病变侧别、累及三叉神经分支、三叉神经根长度比较,差异均无统计学意义(P>0.05);有效组与无效组PTN患者病程、责任血管、血管与神经关系、CPA容积、三叉神经根体积、三叉神经根横截面积比较,差异均有统计学意义(P<0.05)。结论 CPA容积减小、三叉神经根萎缩并体积及横截面积变小是PTN产生的原因。病程长、责任血管为静脉、血管与神经有明确压迫关系、CPA容积小、三叉神经根萎缩并体积及横截面积小的PTN患者行MVD治疗后预后较其他患者差。
Objective To investigate the relationship between the intracranial anatomic parameters and the incidence of primary trigeminal neuralgia (PTN) and the outcome of microvascular decompression (MVD) after lamellar 3D-magnetic resonance imaging (MRI) thin layer scanning. Methods From March 2013 to March 2015, 63 patients with PTN who met the inclusion and exclusion criteria admitted to Department of Neurosurgery, the First Affiliated Hospital of Xinjiang Medical University were selected as the case group, matched with the gender, age and nationality collected at the same time 20 healthy volunteers undergoing MRI examination were selected as the control group. All patients underwent MRI scan and 3D-MRI thin layer scan before operation. The volume of cerebellopontine angle (CPA), the volume of the trigeminal nerve root Volume, the trigeminal nerve root cross-sectional area, the length of the trigeminal nerve and other related anatomical indicators of PTN patients were treated with MVD, divided into effective group according to the prognosis of 50 cases and 13 cases of ineffective group, analysis of general information and posterior fossa related anatomy The relationship between the index and MVD prognosis. Results There were no significant differences in CPA volume, trigeminal nerve root volume, trigeminal nerve root cross-sectional area and trigeminal nerve root length between the left and right sides in the control group (P> 0.05). The volume of contralateral CPA, the volume of trigeminal nerve root and the cross-sectional area of trigeminal nerve root in PTN patients were smaller than those in healthy (P <0.05). There was no significant difference in the length of trigeminal nerve between healthy and affected sides (P> 0.05). There was no significant difference in the length of the trigeminal nerve between the effective group and the ineffective group in terms of gender, age, ethnicity, lesion side, trigeminal nerve involvement and trigeminal nerve root length (P> 0.05). The duration and responsibility of PTN patients Vascular, vascular and neural relationship, CPA volume, trigeminal nerve root volume, trigeminal nerve root cross-sectional area, the difference was statistically significant (P <0.05). Conclusions The decrease of CPA volume, the trigeminal nerve root atrophy and the decrease of volume and cross-sectional area are the causes of PTN. Long course of disease, responsible for the veins of blood vessels, blood vessels and nerves have a clear pressure relationship, CPA small volume, trigeminal nerve root atrophy and small size and cross-sectional area of PTN patients undergoing MVD prognosis worse than other patients.