Morphological Observation Of Trigeminal Nerve Cisternal Segment And Correlation Research Of Sectional Area Of Horizontal Cerebellopontine Angle Cistern Via Trigeminal Nerve In Trigeminal Neuralgia MRI Diagnosis

Objective:adopt three-dimensional constructive interference in the steady state(3D CISS) to measure the length and width of the trigeminal nerve(TN) cisternal segment, the angle between the trigeminal nerve and the pons, the relationship between the primary trigeminal neuralgia offending vessel pressure part and the facial pain area mapped range and the cross sectional area of horizontal cerebellopontine angle cistern via trigeminal nerve,explore the value and clinical significance of the changes in the morphologies of the trigeminal nerve root cisternal segment and the changes in the sectional areas of the trigeminal nerve pressure part and horizontal cerebellopontine angle cistern via trigeminal nerve due to the offending vessels in classical trigeminal neuralgia(CTN) MRI diagnosis and provide more information for clinical practice, which is conducive to clinical choose of further treatment scheme.Method: select 30 cases of patients with trigeminal neuralgia(TN) in our hospital who have been clinically diagnosed and improved after gamma knife treatment, select 100 consecutive cases of patients with not trigeminal neuralgia. All patients have undergone skull MRI plain scan, including axial SE T1 WI, TSE T2 WI and FLAIR sequence; sagittal SE T1 WI sequence and skull cerebral diffusion weighted imaging with the exception of the brainstem and cerebellopontine angle cistern tumor, brainstem inflammation, infarction,hemorrhage, aneurysm, etc. Then carry out Re MRI 3D Ciss sequence check,take axial scanning as the original data image and conduct the multiplanar reconstruction(MPR) to find a axial image which can completely display the bilateral trigeminal nerve cisternal segment as a standard level and measurethe trigeminal nerve cisternal segment length, the root exit zoon(REZ) width and the angle between the trigeminal nerve root and pons; assess the digression of the trigeminal nerve pressed by offending vessels; refer to the measurement method of the cross-sectional area of the cerebellopontine angle cistern by Kawano Et al for the measurement on the cross-sectional area of the cerebellopontine angle cisterns on both sides and manually measure the cross-sectional area of the trigeminal nerve root horizontal cerebellopontine angle cistern; conduct manual drawing and measurement along the basilar clivus, temporal bone petrous part rear edge, cerebellum and pons edge with the basilar clivus midline and brainstem basilar artery groove connection line as the midline and calculate its cross sectional area by the computer. Apply the SPSS 11.5 For Windows statistical software for data analysis, P <0.05,illustrating that it is statistically significant.Result: the cross-sectional area of the side cerebellopontine angle cistern for the patients with trigeminal neuralgia is 162.85±64.44 mm and the cross-sectional area of the uninjured side cerebellopontine angle cistern is190.6±68.27 mm, there are differences between them, and it has statistical significance; the affected side angle between the trigeminal nerve root segment and the pons is 34.55±10.54°,the uninjured side angle is40.05±8.32°,there is difference between them, P=0.003,and it has statistical significance. Trigeminal nerve cisternal segment length, trigeminal nerve the REZ segment width is compared between group and group P values > 0.05, no statistical significance; There are 19 cases(accounting for 63%) that the offending vessels press the trigeminal nerve intermediate part and the top part,10 cases(accounting for 33%) that the offending vessels press the trigeminal nerve top part and the outer side and 1 case(accounting for 3%) that the press offending vessels press the trigeminal nerve lower part.Conclusion:1 The morphological observation can be carried out on the trigeminal nerve cisternal segment of patients with classical trigeminal neuralgia with MRI 3D CISS sequence.2 There is no significant difference between the length and width of the cisternal segment of patients with trigeminal neuralgia at the affected side and that at the uninjured aide; There is a statistical significance in the values(including the cross sectional area of cerebellopontine angle cistern and the angle between the trigeminal nerve root segment and the pons) between the affected side and the uninjured aide.3 There is a statistical significance between the difference value between the cross sectional area of cerebellopontine angle cistern for the patients with the trigeminal neuralgia at the affected side and that at the uninjured side and the difference value between normal control group; however, there is no statistical significance in the difference values(including the difference value in the angle of the trigeminal nerve root and pons between the affected side and the uninjured side, the difference value in the trigeminal nerve cisternal segment length between the affected side and the uninjured side and the difference value in the cisternal segment width between the affected side and the uninjured side) between the disease group and the normal control group.4 The middle part and top part of the trigeminal nerve are most commonly pressed by the offending vessels, followed by the upper part and outer side, and the lower part is pressured rarely.