| BackgroundOculomotor nerve paralysis was a common clinical symptom in the neurosurgery and ophthalmology,because a longer distance of oculomotor nerve,its surrounding adjacent structures with relationship was complex,so the etiology of oculomotor nerve paralysis was also complicated.MRI 3D-FIESTA sequence could make the cerebrospinal fluid and slow the flow liquid had high signal,cranial nerve and cerebrovascular had low signal,the cisternal segment of oculomotor nerve was clearly in cerebrospinal fluid.ObjectiveUsing anatomical specimens and MRI 3D-FIESTA sequence,combined with MPR technology and the treatment of cerebrovascular pathological,the length,angle and its relationship with the location of the peripheral vascular and clinical application of the cisternal segment of oculomotor nerve were researched on different age,to provide morphological basis for image diagnosis of oculomotor nerve paralysis lesions.Materials and methodsAdult cadaveric head specimens of 20 patients,4 were female and 16 were male,the superciliary arch plane through the skull,observing the cisternal segment of oculomotor nerve length,angle,and position of adjacent vessels.The 3D-FIESTA sequences of MRI were collected in 140 cases,male and female,each of 70 cases,aged from 7 to 68 years old.According to the age of 10 years old group,11 to 20 years old group,21 to 30 years old group,31 to 40 years old group,41 to 50 years old group,51 to 60 years old group,60 years old group,20 cases,male and female each 10 cases.Collected 30 cases oculomotor nerve paralysis hospitalization patients,it was 23 cases with cerebral aneurysm oppression,7 cases with cerebrovascular oppression,the ages from25 to 47 years old.The original MRI image data to the 3D reconstruction workstation,using image postprocessing system based on MPR technology,the cisternal segment of oculomotor nerve courser,respectively in oblique transverse and oblique sagittal restructuring,observation of the cisternal segment of oculomotor nerve length,angle,and position of adjacent vessels.Using SPSS 17 software for statistical processing.Results1.The anatomical specimens length,median sagittal plane angle,back sides of brain stem angle of the cisternal segment of oculomotor nerve were(12.37±1.22)mm,(24.43±2.44)°,(69.38±6.54)° respectively,there was no significant difference between the left and right,the male and female(P>0.05).The major blood vessels on the back sides of cisternal segment of oculomotor nerve were the posterior cerebral artery and posterior communicating artery etc,its adjacent rate were 100%(40/40),12.5%(5/40).The major blood vessels on ventral was the superior cerebellar artery,basilar artery,etc,its adjacent rate was 100%(40/40),100%(40/40).2.On the MRI 3D-FIESTA sequence images,the length,median sagittal plane angle,back sides of brain stem angle of the cisternal segment of oculomotor nerve on <10 years old group,11~20 years old group,21~30 years old group,31~40 years old group,41~50years old group,51~60 years old group,>60 years old group,there was no significant difference between the left and right,the male and female(P>0.05).The length between the MRI reconstruction images and the anatomical specimens had significant difference(P<0.05),the magnetic resonance imaging(MRI)reconstruction image was greater than that of the anatomical specimens.The angle between the MRI reconstruction images and the anatomical specimens had no significant difference(P> 0.05).The angle on cisternal segment of oculomotor nerve with brainstem dorsal,there was significant differencebetween the <10 years old group and 11~20 years old group,21~30 years old group,31~40years old group,41~50 years old group(P<0.05),there was significant difference between the >60 years old group and the other groups(P< 0.05).3.On the MRI 3D-FIESTA sequence images,the contact rate and separation rate between the cisternal segment of oculomotor nerve and superior cerebellar artery,posterior cerebral artery,basilar artery,posterior communicating artery were 60.0%(168/280)and40.0%(112/280),55.7%(156/280)and 44.3%(124/280),4.3%(12/280)and 95.7%(168/280),2.9%(8/280)and 97.1%(272/280),there were significant difference between the separation rate and the contact rate(P<0.05),the contact rate was greater than separation rate on the superior cerebellar artery and posterior cerebral artery,the contact rate was less than separation rate on the basal artery and posterior communicating artery.The ventral and dorsal position relationship were significant difference between the superior cerebellar artery,posterior cerebral artery,basilar artery,posterior communicating artery and the cisternal segment of oculomotor nerve(P<0.05),the superior cerebellar artery was more ventral that of oculomotor nerve,posterior cerebral artery,basilar artery and posterior communicating artery was more back side that of the oculomotor nerve.There were significant difference on the superior cerebellar artery,posterior cerebral artery were cross the distal,middle,near segment of the cisternal segment of oculomotor nerve(P<0.05),the superior cerebellar artery,posterior cerebral artery were more across the middle of the cisternal segment of oculomotor nerve.4.There were no significant differences between the endovascular group and surgical group,between the part oculomotor nerve paralysis and completely oculomotor nerve paralysis befor the suigical,between the symptoms in 2 weeks and after 2 weeks surgery of the oculomotor nerve paralysis(P>0.05).Conclusion1.The different ages cisternal segment of oculomotor nerve and brainstem differences between dorsal angle,cisternal segment of oculomotor nerve image diagnosisand surgery,should take into account the age factor on cisternal segment of oculomotor nerve.2.Cerebral arteries with the location and direction relations of cisternal segment of oculomotor nerve was different,it could not completely according to the degree of movement disorders to determine the size of a brain aneurysm,and should be assisted to accompany symptoms and imaging diagnosis. |
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