Alper Judy, Shrivastava Raj K, Balchandani Priti
Icahn School of Medicine at Mount Sinai, The Translational and Molecular Imaging Institute, New York, New York, USA; Grove School of Engineering, Department of Biomedical Engineering, City College of New York, New York, New York, USA.
Department of Neurosurgery, Mount Sinai Medical Center, New York, New York, USA.
World Neurosurg. 2017 Feb;98:89-97. doi: 10.1016/j.wneu.2016.10.104. Epub 2016 Oct 27.
Trigeminal neuralgia (TN) is a chronic brain condition involving the trigeminal nerve and characterized by severe and recurrent facial pain. Although the cause of TN has been researched extensively, there is a lack of convergence on the physiologic processes leading to pain symptoms. This review seeks to better elucidate the underlying pathophysiology of TN by analyzing the outcomes of studies that use magnetic resonance structural imaging and diffusion-weighted imaging to examine nerve damage in patients with TN.
Performing a structured review of the literature, the authors included human magnetic resonance anatomic and diffusion-weighted imaging studies aimed at visualizing the trigeminal nerve or measuring neural damage pertaining to TN. Studies that measured and compared nerve damage in the affected and unaffected sides in patients or patients and controls were analyzed for neural changes associated with TN.
Twenty-five studies met inclusion criteria. Overall, the data from the anatomic and diffusion studies showed decreased volume and cross-sectional area, decreased fractional anisotropy, and increased apparent diffusion coefficient and diffusivity associated with the affected side of patients compared with the unaffected side as well as in patients compared with controls.
A review of the studies included indicates that neural differences exist between the affected and unaffected sides in patients as well as between patients and controls in both structural and diffusion metrics. The amalgamated data suggest that damage of the trigeminal nerve tissue is commonly found in patients with TN and could be a primary factor in TN pathophysiology.
三叉神经痛（TN）是一种涉及三叉神经的慢性脑部疾病，其特征为严重且反复发作的面部疼痛。尽管对TN的病因已进行了广泛研究，但对于导致疼痛症状的生理过程仍缺乏共识。本综述旨在通过分析使用磁共振结构成像和扩散加权成像来检查TN患者神经损伤的研究结果，更好地阐明TN的潜在病理生理学。
作者对文献进行了结构化综述，纳入了旨在可视化三叉神经或测量与TN相关的神经损伤的人体磁共振解剖学和扩散加权成像研究。分析了测量和比较患者患侧与未患侧或患者与对照组神经损伤的研究，以确定与TN相关的神经变化。
25项研究符合纳入标准。总体而言，解剖学和扩散研究的数据显示，与未患侧相比，患者患侧以及与对照组相比，患者的神经体积和横截面积减小，各向异性分数降低，表观扩散系数和扩散率增加。
对纳入研究的综述表明，在患者的患侧与未患侧之间以及患者与对照组之间，在结构和扩散指标方面均存在神经差异。综合数据表明，TN患者中常见三叉神经组织损伤，这可能是TN病理生理学的一个主要因素。
