MRI三维观察血管压迫神经根在原发性三叉神经痛患者和非疼痛人群中差异

doi:10.13418/j.issn.1001-165x.2023.6.07

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中国临床解剖学杂志 ›› 2023, Vol. 41 ›› Issue (6) : 667-674. DOI: 10.13418/j.issn.1001-165x.2023.6.07

断层影像解剖

MRI三维观察血管压迫神经根在原发性三叉神经痛患者和非疼痛人群中差异

刘展，陶胜忠*，卢慧鹏，王在斌，睢豫擘，牛光明

作者信息 +

The differences of neurovascular compression in patients with or without primary trigeminal neuralgia by three-dimensional observation

Liu Zhan, Tao Shengzhong*, Lu Huipeng, Wang Zaibin, Sui Yubo, Niu Guangming

Author information +

文章历史 +

摘要

目的以影像解剖学论证血管神经根冲突（neurovascular conflict or compression，NVC）是引起原发性三叉神经痛（idiopathic trigeminal neuralgia，PTN）的主要病因，完善NVC理论。方法对PTN组（n=48侧）和无痛侧组（n=84侧）脑干区MRI进行多模态影像融合及三维体绘制重建，观察两组血管和神经接触比率，测量接触点与神经根距离、接触点血管袢弯曲程度以及血管袢平面与神经长轴的夹角。结果疼痛侧动脉和神经接触的比率高于无疼痛侧，接触点较集中于三叉神经出脑干区。疼痛侧接触点血管袢曲率0.21中位数（0.07四分位间距）mm^-1，血管袢平面神经夹角线-面角36.18°中位数（12.47°四分位间距），线-线角36.68°中位数（15.67°四分位间距）；非疼痛侧曲率0.12中位数（0.03四分位间距）mm^-1，夹角24.56°中位数（12.09°四分位间距）和26.28°中位数（17.49°四分位间距），两组比较存在明显差异（P<0.05）。疼痛和接触点位于入脑干区（root entrance zone，REZ）、血管袢曲率及血管袢神经夹角相关（P<0.05）。结论责任动脉在PTN患者疼痛侧以更弯曲的弧度和更大的血管神经夹角，更集中地压迫三叉神经REZ区，这种特异性压迫与疼痛相关。

Abstract

Objective To demonstrate that the neurovascular conflict or compression (NVC) is the primary cause of idiopathic trigeminal neuralgia (PTN) by imaging anatomy, so as to perfect the NVC theory. Methods The brain stem MRI of PTN group (n=48 sides) and painless group (n=84 sides) were reconstructed by multi-modal image fusion and three-dimension volume rendering. The contact ratio of blood vessel and nerve, the bending degree of compressing artery, compression site and angle degree between the arterial loop and the main axis of trigeminal nerve were measured and compared between the PNT group and the painless group. Results The contact ratio of artery and nerve in the pain side was higher than that in the non-pain side, the compression site was mostly located in the brain stem area of the trigeminal nerve. On the painful side of patients with PTN, the arterial curvature ( 0.21（0.07）mm^1) and angle degree ( 36.18（12.47）°and 36.68（15.67）°) between the artery and nerve were both significantly higher than those of them (0.12（0.03）mm^1, 24.56（12.09）°and 26.28（17.49）°) on the unaffected side of PTN and without PTN patients. On the painful side, distribution of compression site was significantly focused on root of entrance zone (REZ). There was no significant difference in the compression site, arterial curvature and angle degree between the artery and nerve amongst the healthy sides. Conclusions On the painful side of patient with PTN, there is a significantly curved artery pressing on the root of trigeminal nerve at a large angle degree, and this phenomenon is associated with PTN symptoms.

导出引用

刘展, 陶胜忠, 卢慧鹏, 王在斌, 睢豫擘, 牛光明. MRI三维观察血管压迫神经根在原发性三叉神经痛患者和非疼痛人群中差异[J]. 中国临床解剖学杂志. 2023, 41(6): 667-674 https://doi.org/10.13418/j.issn.1001-165x.2023.6.07

Liu Zhan, Tao Shengzhong, Lu Huipeng, Wang Zaibin, Sui Yubo, Niu Guangming. The differences of neurovascular compression in patients with or without primary trigeminal neuralgia by three-dimensional observation [J]. Chinese Journal of Clinical Anatomy. 2023, 41(6): 667-674 https://doi.org/10.13418/j.issn.1001-165x.2023.6.07

中图分类号： R745.11

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