Neurological Surgery 脳神経外科35巻1号

2007年01月発行

研究

三叉神経痛におけるneurovascular compressionの画像評価―Boundary fusion three-dimensional magnetic resonance cisternogram/angiogramの応用

著者： 佐藤透¹ 尾美賜¹ 大迫知香¹ 小野田恵介² 伊達勲²

所属機関： ¹医療法人社団）涼風会　佐藤脳神経外科脳神経外科 ²岡山大学大学院医歯薬学総合研究科神経病態外科学

ページ範囲：P.33 - P.41

Ⅰ．はじめに

　特発性三叉神経痛において，責任血管による神経の圧迫状況を詳細に把握することは，診断のみならずmicrovascular decompression（MVD）の治療計画を立てるうえでも有用である^11,16-18)．最近のmagnetic resonance（MR）imagingとcomputer medical visualization softwareの技術革新により，三叉神経root entry zone（REZ）での神経と血管との圧迫状況（neurovascular compression）を立体的に画像評価することが可能となっている^10,16,18)．

　今回，構造物の境界面を選択的に描出するboundary fusion three-dimensional（3D）MR cisternogram/angiogramを新たに創作し，三叉神経痛におけるneurovascular compressionの画像評価に応用した^11,13-18)．Boundary imageでは，脳幹あるいは三叉神経内に仮想的視点をおき，境界面をring状に描出することで，脳実質や脳神経を透視して圧迫責任血管が同定可能であった．また，神経走行の軸方向を基準とすることで，神経と責任血管との解剖学的位置関係，ならびに神経の圧迫程度を標準化して立体表示することが可能となった．術前画像所見を臨床症状（疼痛領域）およびMVD術中所見と対比した結果，boundary fusion 3D MR cisternogram/angiogramは三叉神経痛におけるneurovascular compressionの評価に有用と考えられたので報告する．

参考文献

1）Akimoto H, Nagaoka T, Nariai T, Takada Y, Ohno K, Yoshino N：Preoperative evaluation of neurovascular compression in patients with trigeminal neuralgia by use of three-dimensional reconstruction from two types of high resolution magnetic resonance imaging. Neurosurgery 51：956-962, 2002

2）Anderson VC, Berryhill PC, Sandquist MA, Caiverella DP, Nesbit GM, Burchiel KJ：High-resolution three-dimensional magnetic resonance angiography and three-dimensional spoiled gradient-recalled imaging in the evaluation of neurovascular compression in patients with trigeminal neuralgia. A double-blind pilot study. Neurosurgery 58：666-673, 2006

3）Chávez G, De Salles AAF, Solberg TD, Pedroso A, Espinoza D, Villablanca P：Three-dimensional fast imaging employing steady-state acquisition magnetic resonance imaging for stereotactic radiosurgery of trigeminal neuralgia. Neurosurgery 56：E628, 2005

4）Erbay SH, Bhadelia RA, O’Callaghan M, Gupta P, Riesenburger R, Krackov W, Polak JF：Nerve atrophy in severe trigeminal neuralgia：noninvasive confirmation at MR imaging-- initial experience. Radiology 238：689-692, 2006

5）Hitotsumatsu T, Matsushima T, Inoue T：Microvascular decompression for treatment of trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia. Three surgical approach variations, Technical note. Neurosurgery 53：1436-1443, 2003

6）Jannetta PJ：Observations on the etiology of trigeminal neuralgia, hemifacial spasm, acoustic nerve dysfunction and glossopharyngeal neuralgia：Definitive microsurgical treatment and results in 117 patients. Neurochirurugia 20：145-154, 1977

7）Kondo A：Follow-up results of microvascular decompression in trigeminal neuralgia and hemifacial spasm. Neurosurgery 40：46-52, 1997

8）三上　毅，南田善弘，八巻稔明，馬場雄大，宝金清博：Fast imaging employing steady-state acquisition (FIESTA)による神経血管減圧術の術前術後評価．脳外誌14：683-688, 2005

9）Naganawa S, Koshikawa T, Fukatsu H, Ishigaki T, Fukuta T：MR cisternography of the cerebellopontine angle. Comparison of three-dimensional fast asymmetrical spin-echo and three-dimensional constructive interference in the steady-state sequences. AJNR Am J Neuroradiol 22：1179-1185, 2001

10）Naraghi R, Hastreiter P, Tomandl B, Bonk A, Huk W, Fahlbusch R：Three-dimensional visualization of neurovascular relationships in the posterior fossa：technique and clinical application. J Neurosurg 100：1025-1035, 2004

11）小野田恵介，佐藤　透，三好康之，徳永浩司，杉生憲志，伊達　勲：片側顔面痙攣に対するmicrovascular decompressionの新しい術前画像評価．3D MR cisternogram/angiogram fusion imagingの応用．No Shinkei Geka 34：785-791, 2006

12）Samii M, Günther T, Iaconetta G, Muehling M, Vorkapic P, Samii A：Microvascular decompression to treat hemifacial spasm：long-term results for a consecutive series of 143 patients. Neurosurgery 50：712-719, 2002

13）Satoh T, Omi M, Ohsako C, Katsumata A, Yoshimoto Y, Tsuchimoto S, Onoda K, Tokunaga K, Sugiu K, Date I：Visualization of aneurysmal contours and perianeurysmal environment with conventional and transparent 3D MR cisternography. AJNR Am J Neuroradiol 26：313-318, 2005

14）Satoh T, Omi M, Ohsako C, Katsumata A, Yoshimoto Y, Tsuchimoto S, Onoda K, Tokunaga K, Sugiu K, Date I：Influence of perianeurysmal environment on the deformation and bleb formation of the unruptured cerebral aneurysm. Assessment with fusion imaging of 3D MR cisternography and 3D MR angiography. AJNR Am J Neuroradiol 26：2010-2018, 2005

15）Satoh T, Omi M, Ohsako C, Fujiwara K, Tsuno K, Sasahara W, Onoda K, Tokunaga K, Sugiu K, Date I：Differential diagnosis of the infundibular dilation and aneurysm of internal carotid artery. Assessment with fusion imaging of the MR cisternography/ angiography. AJNR Am J Neuroradiol 27：306-312, 2006

16）佐藤　透，小野田恵介，伊達　勲：特発性三叉神経痛における圧迫責任血管の画像評価．脳外誌 15：611-618, 2006

17）Satoh T, Onoda K, Date I：Fusion imaging of three-dimensional magnetic resonance cisternograms and angiograms for the assessment of microvascular decompression in patients with hemifacial spasms. J Neurosurg 106：2007 (in press)

18）Satoh T, Onoda K, Date I：Preoperative simulation for microvascular decompression in patients with idiopathic trigeminal neuralgia：Visualization with 3D MR cisternogram/angiogram fusion imaging. Neurosurgery 60：2007 (in press)

19）Sindou M, Howeidy T, Acevedo G：Anatomical observations during microvascular decompression for idiopathic trigeminal neuralgia (with correlations between topography of pain and site of the neurovascular conflict). Prospective study in a series of 579 patients. Acta Neurochir (Wien) 144：1-13, 2002

20）Yoshino N, Akimoto H, Yamada I, Nagaoka T, Tetsumura A, Kurabayashi T, Honda E, Nakamura S, Sasaki T：Trigeminal neuralgia：evaluation of neuralgic manifestation and site of neurovascular compression with 3D CISS MR imaging and MR angiography. Radiology 228：539-545, 2003