Neurological Surgery 脳神経外科52巻1号

2024年01月発行

特集 脳神経圧迫症候群のすべて—診断・治療・手術のポイント Ⅱ 三叉神経痛

三叉神経痛の画像診断

著者： 有田和徳¹²

所属機関： ¹翠清会梶川病院 ²出水郡医師会広域医療センター

ページ範囲：P.51 - P.62

Point
・三叉神経根に対する血管性の圧迫をMRIで証明するためには，高分解能3D-T2強調像（FIESTA, CISSなど），3D-TOF-MRA，造影3D-T1強調像の組み合わせや，これらの融合画像が有用である．
・神経血管減圧手術の効果が高いのは動脈性の圧迫で，そのなかでも，三叉神経の偏位，屈曲，ねじれ，萎縮を伴うような圧迫の強いものである．
・三叉神経根に対する動脈性圧迫は，必ずしも橋に近い部分（REZ）に限らず，脳槽内中央付近やメッケル腔側での圧迫もある．
・静脈性の圧迫は10〜20%で認められ，横橋静脈によるものが最多で，REZより末梢側での圧迫も多い．静脈性圧迫の検出には，造影3D-T1強調像や高分解能3D-T2強調像とCT血管造影の融合像が有用である．
・健常者でも三叉神経根に対する血管接触は高率に認められ，時に圧迫所見を示すこともある．神経血管減圧手術を決定する前に，症状が典型的であること，二次性三叉神経痛の可能性がないことを確認する必要性がある．

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