Analysis Of Operation Indication Value For Primary Trigeminal Neuralgia Symptom And Iconography

Objective:To investigate the clinical value of preoperative imaging examination and clinical symptoms of primary trigeminal neuralgia in patients with microvascular decompression.Method:A retrospective analysis from January 2012 to December 2015 in The First Hospital of Shanxi Medical University, there were 128 cases of patients with trigeminal neuralgia and their imaging data in neurosurgery.Exclusion of patients with atypical trigeminal neuralgia and secondary trigeminal neuralgia and non operative treatment,there were 67 cases of typical primary trigeminal neuralgia,the same surgical physician group to analyze the clinical symptoms of patientsand and the relationship between trigeminal nerve and blood vessels in three dimensional time-of-flight magnetic resonance angiography(3D-TOF-MRA) examination,the results of 3D-TOF-MRA were divided into positive group and negative groupand,and compared with intraoperative findings,observated immediate effect after operation and complications,followed up and record the results.According to the diagnosis and treatment of trigeminal neuralgia in China expert consensus score,the operation effect was divided into great,good,general,failure,Compared the positive group and the negative group,Whether there is difference in the curative effect.Result:There were 67 cases of typical primary trigeminal neuralgia,54 patients were second and third distribution area pain,the proportion was 80.7%,there were fewer patientswith pain in the first distribution area.There were 50 patients with three dimensional time-of-flight magnetic resonance angiography(3D-TOF-MRA)examination that showed the trigeminal nerve and blood vessel ride cross, concomitant,oppression,or contac,the detection rate was 74.6%.There were 48 cases of vascular compression or contact trigeminal nerve in the microvascular decompression, the sensitivity was 96%.The number of negative cases of 3D-TOF-MRA examination before operation was 17 cases,among which there were 9 cases no vascular compression or contact with them,and the specificity was 53%.Postoperative efficacy were divided into great,good,general,failure,a total of 54 patients were great and good,total effective rate 83.6%.The results of preoperative3D-TOF-MRA examination were divided into positive group and negative group,compared with the positive group and negative group,Statistical method was used two independent sample rank sum test,P>0.05,so there was no significant difference between the positive group and the negative group.Conclusion:1.typical trigeminal neuralgia symptoms should be as the operation indication of primary trigeminal neuralgia patients with microvascular decompression,during the operation,we should carefully explore the trigeminal nerve root into the brain stem area,full decompression;2.3D-TOF-MRA imaging features was showed a high sensitivity to the relationship between the trigeminal nerve and the surrounding vessels,it had a guiding significance in preoperative prediction of the responsible vessel,assessment of the operation safety,careful exploration of the important areas in the operation,improve the effectiveness of the operation,and reduce the complications;But 3D-TOF-MRA examination still exist some false negative,therefore, the auxiliary examination method still needs to be further improved.