MRI study of anterior inferior cerebellar artery vascular loops and typical facial and acoustic nerve symptoms in patients with facial and acoustic neurovascular compression syndrome
Zou Jie, Ma Laiyang, Gan Tiejun, Jiang Yanli, Ma Yurong, Zhang Jing
Department of MR, Lanzhou University Second Hospital, Lanzhou 730030, China
Abstract：Objective To investigate whether the typical facial and acoustic nerve symptoms of in patients with facial and acoustic neurovascular compression syndrome are different in different positions of the anterior inferior cerebellar artery (AICA) vascular loop. Methods Retrospective study. A total of 311 patients(622 side ears) who underwent magnetic resonance imaging(MRI) 3-dimensional sampling perfection with application optimized contrast using different flip angle evolutions(3D-SPACE) of the inner ear in the Lanzhou University Second Hospital were retrospectively analyzed. There were 113 males and 198 females, aged (48±10.8) years, with a range of 22-77 years. The incidence of AICA vascular loop and the proportion of Chavda classification were calculated. In 311 cases, 107 cases were unilateral hemifacial spasm. The incidence of AICA vascular loops, the proportion of Chavda classification and whether AICA had contact with nerve during the whole process were compared between the affected side (107 sides) and the normal side (107 sides). Then, 90 patients(148 ears) with positive vascular loop were selected as the vascular loop group, and the clinical manifestations of patients with AICA vascular loops of different Chavda types were compared. Sixty-three ears of Chavda types Ⅱ and Ⅲ were included in the inner auditory canal vascular loop group, and the nerve distribution in the internal auditory canal was divided into four quadrants. The differences of typical facial and acoustic nerve symptoms between patients with different quadrants of AICA vascular loop contacting facial and acoustic nerves were observed. Results The incidence of AICA vascular loops was 65.43%(407/622) in 311 patients, including 144 cases of bilateral AICA loops, 119 cases of unilateral AICA loops, 170 sides of Chavda type Ⅰ (41.77%), 189 sides of type Ⅱ (46.44%), and 48 sides of type Ⅲ (11.79%). The incidence of AICA vascular loop was 71.96% (77/107) in the normal side and 70.09%(75 /107) in the affected side, and no significant difference was observed between the two sides (P＞0.05). The neurovascular contact rates of the normal side and the affected side were 57.9% (62/107) and 43.9%(47/107), respectively. the difference was statistically significant(χ2=4.207, P＜0.05). There was no significant difference in the incidence of hemifacial spasm, hearing loss and tinnitus among 90 patients (148 sides) in vascular loop group (P＞0.05); and there was no significant difference in the typical facial and acoustic nerve symptoms among patients with different quadrants of AICA vascular loop in the 63 sides inner auditory canal group (P＞0.05). No statistically significant differences were observed in the incidence of facial spasm, hearing loss, and tinnitus symptoms among 90 cases (148 sides) with different Chavda types in the vascular loop group (all P values ＞0.05). No statistically significant differences were observed in the typical facial acoustic nerve symptoms among 63 ears with different Chavda types in the quadrant of the inner auditory canal vascular loop group(all P values＞0.05). Conclusions MRI 3D-SPACE imaging of the inner ear can clearly show the vascular loop of AICA and its position relationship with the internal auditory canal. The depth and position of vascular loop have no difference with typical facial and auditory nerve symptoms of facial and auditory nerve compression syndrome.
邹婕, 马来阳, 甘铁军, 姜艳丽, 马玉荣, 张静. 面听神经血管压迫综合征患者小脑下前动脉血管袢与患者典型面听神经症状的MRI研究[J]. 中华解剖与临床杂志, 2020, 25(6): 622-627.
Zou Jie, Ma Laiyang, Gan Tiejun, Jiang Yanli, Ma Yurong, Zhang Jing. MRI study of anterior inferior cerebellar artery vascular loops and typical facial and acoustic nerve symptoms in patients with facial and acoustic neurovascular compression syndrome. Chinese Journal of Anatomy and Clinics, 2020, 25(6): 622-627.
刘兆会, 赵鹏飞, 王振常, 等. 冗长血管袢压迫前庭蜗神经: 引起搏动性耳鸣的原因[J]. 中国耳鼻咽喉头颈外科, 2012, 19(7): 371-373.Liu ZH, Zhao PF, Wang ZC, et al.Redundant vascular compression of the vestibulocochlear nerve: really a cause of pulsatile tinnitus[J]. Chin Arch Otolaryngol Head Nech Surg, 2012, 19(7): 371-373.
[2]
马小贝, 陈维亮, 张小林, 等. 前庭蜗神经及相关小脑下前动脉MRI表现[J]. 实用医药杂志, 2014, 31(4): 301-303.Ma XB, Chen WL, Zhang XL, et al.MRI about vestibulocochlear nerve and anterior inferior cerebellar artery[J]. Prac J Med Pharm, 2014, 31(4): 301-303.
[3]
Brandt T, Strupp M, Dieterich M. Vestibular paroxysmia: a treatable neurovascular cross-compression syndrome[J]. J Neurol, 2016, 263 Suppl 1: S90-S96. DOI:10.1007/s00415-015-7973-3.
[4]
孙伟, 张澍杰, 饶圣祥, 等. 磁共振3D-SPACE序列对面肌痉挛病因的诊断价值[J]. 中国医学计算机成像杂志, 2019, 25(3): 217-221. DOI:10.3969/j.issn.1006-5741.2019.03.001.Sun W, Zhang SJ, Rao SX, et al.Etiological diagnosis value of MR 3D-SPACE sequence in patients with hemifacial spasm[J] Chin Comput Med Imag, 2019, 25(3): 217-221. DOI:10.3969/j.issn.1006-5741.2019.03.001.
[5]
周国庆, 姜岐涛, 韩峰, 等. 前庭阵发症患者高分辨MR和前庭神经功能检查的临床研究[J]. 中国实用神经疾病杂志, 2018, 21(13): 1419-1423. DOI:10.12083/SYSJ.2018.13.334.Zhou GQ, Jiang QT, Han F, et al.Clinical study of contradiction and correlation in vestibular paroxysmia from high resolution MR and vestibular function examination[J]. Chinese Journal of Practical Nervous Diseases, 2018, 21(13): 1419-1423. DOI:10.12083/SYSJ.2018.13.334.
[6]
de Abreu Junior L, Kuniyoshi CH, Wolosker AB, et al. Vascular loops in the anterior inferior cerebellar artery, as identified by magnetic resonance imaging, and their relationship with otologic symptoms[J]. Radiol Bras, 2016, 49(5): 300-304. DOI:10.1590/0100-3984.2015.0069.
[7]
Romano N, Federici M, Castaldi A.Imaging of cranial nerves: a pictorial overview[J]. Insights Imaging, 2019, 10(1): 33. DOI:10.1186/s13244-019-0719-5.
[8]
Cetica V, Pende D, Griffiths GM, et al.Molecular basis of familial hemophagocytic lymphohistiocytosis[J]. Haematologica, 2010, 95(4): 538-41. DOI:10.3324/haematol,2009.019562.
[9]
Montava M, Rossi V, CurtoFais CL, et al. Long-term surgical results in microvascular decompression for hemifacial spasm: efficacy, morbidity and quality of life[J]. Acta Otorhinolaryngol Ital, 2016, 36(3): 220-227. DOI:10.14639/0392-100X-899.
[10]
陈立华, 陈凌, A Samii, 等. 小脑下前动脉显微外科应用解剖的研究[J]. 中国脑血管病杂志, 2006, 3(10): 445-449. DOI:10.3969/j.issn.1672-5921.2006.10.004.Chen LH, Chen L, A Samii, et al. Microsurgical anatomy of the anterior inferior cerebellar artery: an applicative study[J]. Chin J Cerebrovasc Dis, 2006, 3(10): 445-449. DOI:10.3969/j.issn.1672-5921.2006.10.004.
[11]
Kim SH, Ju YR, Choi JE, et al.Anatomical location of AICA loop in CPA as a prognostic factor for ISSNHL[J]. PeerJ, 2019, 7: e6582. DOI:10.7717/peerj.6582.
[12]
Alonso F, Kassem MW, Iwanaga J, et al.Anterior inferior cerebellar arteries juxtaposed with the internal acoustic meatus and their relationship to the cranial nerve Ⅶ/Ⅷ complex[J]. Cureus, 2017, 9(8): e1570. DOI:10.7759/cureus.1570.
[13]
Kazawa N, Togashi K, Ito J.The anatomical classification of AICA/PICA branching and configurations in the cerebellopontine angle area on 3D-drive thin slice T2WI MRI[J]. Clin Imaging, 2013, 37(5): 865-870. DOI:10.1016/j.clinimag.2011.11.021.
[14]
Makins AE, Nikolopoulos TP, Ludman C, et al.Is there a correlation between vascular loops and unilateral auditory symptoms?[J]. Laryngoscope, 1998, 108(11 Pt 1): 1739-1742. DOI:10.1097/00005537-199811000-00027.
[15]
Toulgoat F, Sarrazin JL, Benoudiba F, et al.Facial nerve: from anatomy to pathology[J]. Diagn Interv Imaging, 2013, 94(10): 1033-1042. DOI:10.1016/j.diii.2013.06.016.
[16]
Haller S, Etienne L, Kövari E, et al.Imaging of neurovascular compression syndromes: trigeminal neuralgia, hemifacial spasm, vestibular paroxysmia, and glossopharyngeal neuralgia[J]. AJNR Am J Neuroradiol, 2016, 37(8): 1384-1392. DOI:10.3174/ajnr.A4683.
[17]
王冰, 鲜军舫, 王振常, 等. 耳鸣患者颞骨异常的CT及MRI研究[J]. 中华放射学杂志, 2011, 45(3): 255-259. DOI:10.3760/cma.j.issn.1005-1201.2011.03.006.Wang B, Xian JF, Wang ZC, et al.CT and MRI findings of temporal bone anomaly in patients with tinnitus[J]. Chin J Radiol, 2011, 45(3): 255-259. DOI:10.3760/cma.j.issn.1005-1201.2011.03.006.
[18]
李春星, 符益纲, 周笑, 等. 磁共振序列在颅神经血管成像中的应用价值[J]. 磁共振成像, 2016, 7(3): 180-184. DOI:10.12015/issn.1674-8034.2016.03.004.Li CX, Fu YG, Zhou X, et al.The application value of MR sequence in cranial neurovascular imaging[J]. Chin J Magn Reson Imag, 2016, 7(3): 180-184. DOI:10.12015/issn.1674-8034.2016.03.004.
2020, Vol. 25 
