Comparative Analysis On Findings Between3.0T Magnetic Resonance Imaging Of Trigeminal Neuralgia And Microvascular Decompression Surgery

Objective: To perform3.0T MRI and the measurement of the middlecross-sectional area of the trigeminal nerve root on patients with primary trigeminalneuralgia before surgery. To explore the etiological diagnosis of MRI for trigeminalneuralgia to provide the exact basis for microvascular decompression surgery, furtherimproving the cure rate of TN.Methods: Twenty-one patients with primary trigeminal neuralgia were collectedfrom our hospital, and a variety of imaging sequence examinations of magneticresonance tomographic angiography (MRTA) were conducted on them, in turn,including three dimensional time of flight (3D-TOF) and three dimensional fastimaging employing steady-state acquisition (3D-FIESTA) scans, after that,multi-planar reconstruction (MPR) was conducted. And the middle cross-sectionalarea of the trigeminal nerve root was measured. Image reading was conducted usingblinding method to define nerve compression by blood vessels, and thenmicrovascular decompression was performed. Finally, intraoperative findings andMRI findings were compared.Results: In21patients with trigeminal neuralgia, MRTA examination revealed20patients whose blood vessels closely contacted with the trigeminal nerves, and thepositive rate was95.2%. One patient had no blood vessels around the trigeminalnerves, and the negative rate was4.8%. The measurement of the middlecross-sectional area of the trigeminal nerve root showed21patients had obviousatrophy on the affected side compared with the unaffected side. All21patientsunderwent craniotomy, among them,20patients showed obvious vascularcompression in surgery and underwent microvascular decompression surgery, and the remaining one patient had no vascular compression, nerve and arachnoid adhesionscould be seen in surgery, so the lysis of adhesions of trigeminal nerve and arachnoidwas conducted. Intraoperative findings coincided with those of preoperative MRI.Patients were followed up for4-12months, and the average was8months. At the endof the follow-up visit, the total effective rate of the surgery was100%. Maincomplications included postoperative vomiting in six patients, cerebrospinal fluidleakage in one patient and facial paralysis combined with ipsilateral herpes in onepatient, they were all improved before discharge, two patients had facial numbnessthat still existed at the end of the follow-up visit. No deaths or serious complicationswere found in this group.Conclusion: Preoperative3.0T MRI examination of the head shows the trigeminalnerve of patients with trigeminal neuralgia has a certain relationship with vascularcompression. The reduction in the cross-sectional area of the trigeminal nervesindicates nerve root atrophy, which may have a relationship with vascularcompression. Preoperative routine MRI special sequence of the head and otherrelevant examinations has a guiding significance for microvascular decompressionsurgery.