NÖROTOLOJİK SEMPTOMLARI AÇIKLAMADA 7. - 8. SİNİR KOMPLEKSİ İÇİN VASKÜLER LOOP KOMPRESYONUNUN DEĞERLENDİRİLMESİ NE KADAR ETKİLİDİR ?

Öz

AMAÇ: Bu çalışmanın amacı, vestibulokoklear sinirin (VCN) nörovasküler kompresyonunun radyolojik kanıtının tinnitus ve işitme kaybında patognomonik olup olmadığını manyetik rezonans görüntüleme (MRI) “3D Fast Imaging Employing Steady-State Acquisition (FIESTA)” sekansı kullanarak incelemektir.
GEREÇ VE YÖNTEM: Çalışma, sağ ve sol taraf dahil olmak üzere 85 hastada 170 temporal kemik değerlendirilmesi ile gerçekleştirildi. İnternal akustik kanal (İAK) orifisinde 1.5-Tesla MRI kullanılarak, anterior inferior serebellar arterin (AICA) sınıflandırılmış vasküler kompresyonları (Chavda sınıflandırması), AICA, superior serebellar arter (SCA) ve vertebral arter (VA) kompresyonu veya VCN'in distorsiyonu arasındaki anatomik ilişkinin noninvaziv değerlendirmesi yapıldı.
BULGULAR: Değerlendirilen 85 hastadan 36'sında (%42.4) vasküler loop izlenmedi. Chavda sınıflandırmasına göre 41'inde (%48.2) 1. derece vasküler loop, 7'sinde (%8.2) 2. derece vasküler loop ve 1'inde (%1.2) 3. derece vasküler loop saptandı. Ayrıca hastaların 6’sında (%7.1) VA kompresyonu ve 3’ünde (%3.5) SCA kompresyonu görüntülendi. Tinnitus şikayeti olan 16 (%32) hastada IAC distorsiyonu görüldü. Vasküler loop varlığı da sırasıyla tinnitus olmayan (%62.9) ve sağlıklı işiten (%51.8) olgularda yüksek insidans gösterdi. Hastaların nörotolojik semptomları için AICA loop tipleri, VA veya SCA ve IAC distorsiyonunun varlığı ve yokluğu arasında istatistiksel anlamlı farklılık saptanmadı (p > 0,05).
SONUÇ: Nörovasküler temas nadir bir bulgu değildir ve tinnitusla ilgili gözükmemektedir. Bununla birlikte 3D-FIESTA MRI kullanılması, VCN ve komşu vasküler varyasyonlar ile özellikle AICA varyasyonlarının ilişkisinin belirlenmesini iyi tanımlar ve mikrovasküler operasyonlar için vaka seçimine katkıda bulunur.

Anahtar Kelimeler

• 3D-FIESTA
• İşitme kaybı
• Nörotolojik semptom
• Tinnitus
• Vasküler loop
• Vasküler kompresyon sendromu
• Vestibülokoklear sinir

HOW EFFECTIVE IS THE EVALUATION OF VASCULAR LOOP COMPRESSION FOR THE 7TH-8TH NERVE COMPLEX IN EXPLAINING NEURO - OTOLOGICAL SYMPTOMS ?

Öz

OBJECTIVE: The goal of this research study was to investigate of whether the radiological proof of neurovascular compression of the vestibulocochlear nerve (VCN) was pathognomonic for hearing loss and tinnitus using “3D Fast Imaging Steady-State Acquisition (FIESTA)” magnetic resonance imaging (MRI) sequence.
MATERIAL AND METHODS: The research study was performed in 85 patients by evaluating 170 temporal bones, inclusive of both sides. The non-invasive assessment of the anatomical relationship between the classified vascular compression (Chavda classification) of the anterior inferior cerebellar artery (AICA) and the existence of AICA, superior cerebellar artery (SCA), vertebral artery (VA) compression or distortion of the VCN was applied by using 1.5-Tesla MRI at the internal acoustic canal (IAC).
RESULTS: Of the 85 participants examined, 42.4% (n = 36) presented no vascular loop (VL). 48.2% (n = 41) of the patients produced type 1 VL, 8.2% (n = 7) type 2 VL, and 1.2% (n = 1) type 3 VL accordingly to the Chavda classification. In addition, compressions of redundant VA and SCA were also observed in 7.1% (n = 6) and 3.5% (n = 3) of the patients respectively. Also, IAC distortion was found in 32% (n = 16) patients with tinnitus. The presence of vascular loops also showed a high incidence in patients with normal hearing (51.8%) and without tinnitus (62.9%), respectively. No statistically relevant variations were found between the existence and nonexistence of the VL of AICA forms, VA or SCA, and IAC distortion for the neurotological symptoms of patients (p > 0.05).
CONCLUSIONS: Neurovascular touch is not an uncommon finding. It doesn’t appear to be related to tinnitus. However, the use of 3D-FIESTA MRI well defines the relationship between VCN and adjacent vascular variations and especially AICA variations and contributes to case selection for microvascular operations.

Anahtar Kelimeler

• 3D-FIESTA
• Hearing loss
• Neurotologic symptom
• Vascular loop
• Vascular compression syndrome
• Vestibulocochlear nerve

Kaynakça

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