Imaging Anatomy Of Trigeminal Neurovascular Complex And Clinical Application

Objective Compare the magnetic resonance imaging and virtual reconstruction of trigeminal neurovascular with surgery findings to explore the better technology on image anatomical study of trigeminal neurovascular complex.Method First, 114 cases of patients with trigeminal neuralgia undergoing microvascular decompression surgery were collected from January 2007 to January 2011 in our hospital, 95 cases have complete materials including images and operative. All case's MRTA performance,operational findings and clinical curative effect were analyzed retrospectively. responsible vessel'source and the site of vessel's compression found by the preoperative MRTA were compared to surgical findings to analyses the correlation between vascular compression site and clinical symptoms,as well as advantages and disadvantages of this method on studying the anatomy of trigeminal neurovascular complex. Second, 31 patients with trigeminal neuralgia were scanned preoperatively by 3D-FIESTA sequence and 3D-TOF sequences, the image data were loaded into Dextroscope system to be extracted, fused for reconstruction of trigeminal neurovascular complex. The virtual images were compared to what we had seen during the Micro-vascular Decompression.Results First,MRTA detected 82 cases with responsible vessel in 95 patients with trigeminal neuralgia, the MRTA positive rate is 86.32%. 29 of 35 patients with symptoms related to the maxillary division had their NVC at the medial site of the REZ. 30 of 39 Patients with symptoms related to the mandibular division had their NVC at the lateral site of the REZ. Second, all cases of virtual images all reflect the real relationship of the trigeminal nerve and its adjacent anatomical structure, with high visualization; Comparing the reconstructed images to the surgical findings is highly coincident. 3D-FIESTA sequence played a better role in recreating small blood vessels, 3D-TOF sequence was better for the basilar artery and vertebral artery reconstruction,respectively. The image had higher quality when combing the two sequences. Application of integrate reconstruction not only has better visual effect, but also has higher sensitivity and accuracy than MRTA on the NVC.Conclusion First, MRTA imaging can fairly accurate detected the relationship between vessels and nerves, through multiple plane reconstruction can observe the position of NVC, these data demonstrated a close relationship between the region of neuralgic manifestition and the site of trigeminal nerve compression at the REZ. These is important for selective rhizotomy of the trigeminal nerve in patients with TN but no NVC. Second, 3D-FIESTA MRI and 3D-TOF data both clearly show the anatomy relationship of the trigeminal neurovascular complex, but the two sequences should be combined to show more anatomical details and can make up the disadvantages of each other, it can give fine effect close to the stereo effect entity anatomy. In practical applications found that the method can quickly rebuilt imaging, to Clear stereo display the NVC, could provides useful anatomical information in preoperative decision making, intraoperative guiding and postoperative effect assessment guide, This method have certain clinical potential application.