| Objective:To evaluate the value of neurovascular relationship in the diagnosis of primary trigeminal neuralgia,and to evaluate the accuracy of primary trigemina neuralgia in the diagnosis of primary trigeminal neuralgia shown by MRI,and to provide a reference for the clinical diagnosis and treatment of trigeminal neuralgia.Methods : Following the principles of evidence-based medicine,computer-based databases such as Medline,EMBase,Cochran Library,CNKI,Wanfang,Weipu,etc.were retrieved from January 2005 to December 2016.Manual search as a supplement included the study of neurovascular relationships in the diagnosis of primary trigeminal neuralgia.The quality of the included studies was evaluated jointly by 2 evaluators.The Rev.Man5.3 software was used to perform meta-analysis and data processing on studies that met the inclusion criteria.At the same time,a retrospective analysis of the primary diagnosis of primary trigeminal neuralgia in neurosurgery at the Affiliated Hospital of Qingdao University included 60patients(19 males and 41 females;mean age 57.47 years,age range 29-79).At the age of3 years,all MRI 3D-TOF and 3D-FIESTA sequence tests were performed to obtain the original imaging data,and then imported into the MIP software for further analysis to record whether the image was found to have neurovascular compression,whether a responsible vessel was found,a responsible vessel type,or an oppressed position.And the extent of nerve compression.Check the patient's case and the operation record,and specify in detail the type of responsible vessel,the position of the nerve vessels responsible for compression,and the degree of nerve compression.SPSS 21.0 software was used for statistical analysis of relevant data.P<0.05 showed statistical difference.Results : A total of 9 eligible studies were included,including 1,212 nerves(531symptomatic and 681 asymptomatic).The results of meta-analysis showed that:(1)The detection rate of NVC in MRI OR(95%CI)values is 16.6(11.8-23.3),the difference between two groups(symptomatic and asymptomatic trigeminal nerves)is significant(P<0.01).(2)The detection rate of NVC in the REZ area in MRI OR(95%CI)values is14.7(8.3-25.8),the difference between two groups(symptomatic and asymp tomatic trigeminal nerves)is significant(P<0.01).(3)The combined OR of non-REZ NVC detection rates in symptomatic trigeminal and The detection rate of NVC in the non-REZ area in MRI OR(95%CI)values is 0.81(0.4-1.7),the difference between two groups(symptomatic and asymptomatic trigeminal nerves)is not significant(P=0.58).(4)The detection rate of neuroanatomical changes(such as displacement,deformation,atrophy,etc.)in MRI OR(95%CI)values is 11.8(7.8-17.9),the difference between two groups(symptomatic and asymptomatic trigeminal nerves)is significant(P<0.01).The differences in the detection rate of NVC and NVC in REZ area and neuroanatomical changes in MRI between two groups(symptomatic and asymptomatic trigeminal nerves)are significant(P<0.05).The difference in the detection rate of NVC in non-REZ NVC area a between two groups is not significant(P>0.05).Conclusion: 1.The relationship of neurovascular in MRI has certain value for the diagnosis of primary trigeminal neuralgia.Detecting one indicator(neural vascular compression,neurovascular compression in REZ area,or changes in nerve anatomy)by MRI alone does not provide fully diagnosis of it.2.When high-resolution MRI shows NVC in the REZ area associated with changes in neuroanatomy(such as nerve transposition,deformation,atrophy,etc.),patients with primary trigeminal neuralgia are more likely to present with symptomatic neurovascular compression.3.At present,MRI examination is not yet fully accurate in the diagnosis of primary trigeminal neuralgia and its side.In order to improve the sensitivity of diagnostic methods,it may be necessary to study more complex and innovative imaging techniques and to explore more specific diagnostic indicators. |
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