The Value Of Magnetic Resonance Imaging In The Evaluation And Treatment Of Neurovascular Compression In Patients With Primary Trigeminal Neuralgia

Object:To explore the value of Magnetic resonance(MR)three-dimensional fast imaging employing steady state acquisition(3D-FIESTA)combined with three-dimensional time of flight(3D-TOF)sequence in locating neurovascular compression(NVC)for primary trigeminal neuralgia(TN),and evaluate the value of megnatic resonance virtual endoscopy(MRVE)based on 3D-FIESTA in the surgical treatment of primary trigeminal neuralgia.Methods:A retrospective collection of clinical data on 72 patients with a diagnosis of primary TN was conducted at our institution,which all underwent endoscope-assisted microvascular decompression.Based on MR tomographic angiography,we compared the incidence of NVC,NVC score,the shortest distance from the root entry zone(REZ)of trigeminal nerve to the responsible vessel(RV)and its origin between both sides of symptom and asymptom,MRVE technique was used to simulate the endoscopic image of the cerebral cistern and reconstruct the three-dimensional image to simulate the surgical path,and we compared the results with intraoperative video to evaluate the reliability of MRVE technique and its value for surgery.Results:In the symptomatic side,the rate of NVC was 94.44%(68/72),where the proportion of artery was 95.59%.The most common responsible vessel was superior cerebellar artery(SCA),accounting for 75%(51/68),NVC score was 6.63±2.18.The shortest distance between the responsible vessel and REZ of trigeminal nerve was 1.04±1.55mm.In the asymptomatic side,the rate of NVC was 45.83%(33/72),where the proportion of artery was 66.67%.The most common responsible vessel was SCA,accounting for 57.58%(19/33),NVC score was 2.91±0.95.The shortest distance between responsible vessel and REZ of trigeminal nerve was 5.28±2.33mm.The differences all had statistical significance.The FIESTA images of 68 patients with NVC positive were obtained,the images of the simulated surgical pathways were obtained by MRVE three-dimensional post-processing,which was highly consistent with the surgical video.Conclusion:Primary trigeminal neuralgia is closely related to the NVC,and MR 3D-FIESTA combined with 3D-TOF sequence shows great sensitivities in locating NVC.Based on 3D-FIESTA,MRVE can highly simulate the surgical path and visual field,which has important guiding value for the surgical treatment.