Cheng Jian, Meng Jinli, Liu Wenke, Zhang Heng, Lei Ding, Hui Xuhui
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
Department of Radiology, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region (Hospital.C.T), Chengdu, China.
World Neurosurg. 2017 Aug;104:575-580. doi: 10.1016/j.wneu.2017.05.057. Epub 2017 May 19.
To prospectively evaluate the morphological and structural changes in the trigeminal nerve in patients with trigeminal neuralgia (TN) compared with healthy controls.
We conducted a prospective case-control study of 60 consecutive patients diagnosed with TN and 30 sex-and age-matched healthy controls. All subjects underwent high-resolution 3-dimensional magnetic resonance imaging (MRI). The volume and length of the cisternal segment of the trigeminal nerve and the angle between the trigeminal nerve and the anterior surface of the pons (trigeminal pontine angle) were measured and compared.
The mean volume of the affected trigeminal nerve was significantly reduced compared with that of the nonaffected side (65.8 ± 21.1 mm vs. 77.9 ± 19.3 mm; P = 0.001) and controls (65.8 ± 21.1 mm vs. 74.7 ± 16.5 mm; P = 0.003). The mean trigeminal pontine angle was 42.4 ± 8.7° on the affected side, 47.6 ± 9.2° on the nonaffected side, and 46.0 ± 7.2° in the controls. The trigeminal pontine angle on the affected side was significantly smaller than that on the nonaffected side (P = 0.005) and in controls (P = 0.01). There the was no statistically significant difference in the mean length of the cisternal segment of trigeminal nerve between the affected and nonaffected sides (P = 0.46).
TN is associated with atrophy and a small trigeminal pontine angle in the affected nerve. Nerve atrophy may be a late consequence of chronic physical stress and is likely involved in the pathogenesis of TN. A small trigeminal pontine angle may increase the risk of neurovascular conflict, and thus more likely to result in the genesis of TN.
前瞻性评估三叉神经痛（TN）患者与健康对照者三叉神经的形态和结构变化。
我们对60例连续诊断为TN的患者和30例性别及年龄匹配的健康对照者进行了前瞻性病例对照研究。所有受试者均接受高分辨率三维磁共振成像（MRI）检查。测量并比较三叉神经脑池段的体积和长度以及三叉神经与脑桥前表面之间的夹角（三叉神经脑桥角）。
患侧三叉神经的平均体积与未患侧相比显著减小（65.8±21.1mm对77.9±19.3mm；P = 0.001），与对照组相比也显著减小（65.8±21.1mm对74.7±16.5mm；P = 0.003）。患侧三叉神经脑桥角平均为42.4±8.7°，未患侧为47.6±9.2°，对照组为46.0±7.2°。患侧三叉神经脑桥角显著小于未患侧（P = 0.005）和对照组（P = 0.01）。患侧与未患侧三叉神经脑池段的平均长度差异无统计学意义（P = 0.46）。
TN与患侧神经萎缩及较小的三叉神经脑桥角有关。神经萎缩可能是慢性物理应激的晚期后果，可能参与了TN的发病机制。较小的三叉神经脑桥角可能增加神经血管冲突的风险，从而更易导致TN的发生。
