Neurosurgery Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil,
Neurological Sciences Department - FUNFARME/FAMERP, São José do Rio Preto School of Medicine, São Paulo, Brazil.
Prog Neurol Surg. 2020;35:18-34. doi: 10.1159/000511257. Epub 2020 Oct 6.
The trigeminal nerve complex is a very important and somewhat unique component of the nervous system. It is responsible for the sensory signals that arise from the most part of the face, mouth, nose, meninges, and facial muscles, and also for the motor commands carried to the masticatory muscles. These signals travel through a very complex set of structures: dermal receptors, trigeminal branches, Gasserian ganglion, central nuclei, and thalamus, finally reaching the cerebral cortex. Other neural structures participate, directly or indirectly, in the transmission and modulation of the signals, especially the nociceptive ones; these include vagus nerve, sphenopalatine ganglion, occipital nerves, cervical spinal cord, periaqueductal gray matter, hypothalamus, and motor cortex. But not all stimuli transmitted through the trigeminal system are perceivable. There is a constant selection and modulation of the signals, with either suppression or potentiation of the impulses. As a result, either normal sensory perceptions are elicited or erratic painful sensations are created. Electrical neuromodulation refers to adjustable manipulation of the central or peripheral pain pathways using electrical current for the purpose of reversible modification of the function of the nociceptive system through the use of implantable devices. Here, we discuss not only the distal components, the nerve itself, but also the sensory receptors and the main central connections of the brain, paying attention to the possible neuromodulation targets.
三叉神经复合体是神经系统中非常重要且具有一定独特性的组成部分。它负责来自面部、口腔、鼻腔、脑膜和面部肌肉的大部分感觉信号，以及传递给咀嚼肌的运动指令。这些信号通过一组非常复杂的结构传输：皮肤感受器、三叉神经分支、节神经节、中央核和丘脑，最终到达大脑皮层。其他神经结构直接或间接地参与信号的传递和调制，尤其是痛觉信号；这些结构包括迷走神经、蝶腭神经节、枕神经、颈脊髓、导水管周围灰质、下丘脑和运动皮层。但并非所有通过三叉神经系统传递的刺激都可被感知。信号始终存在选择和调制，冲动被抑制或增强。因此，要么引发正常的感觉感知，要么产生不稳定的疼痛感觉。电神经调节是指使用电流对中枢或外周疼痛通路进行可调节的操作，目的是通过使用可植入设备可逆地改变伤害性系统的功能。在这里，我们不仅讨论了神经本身的远端成分，还讨论了感觉受体和大脑的主要中枢连接，并关注了可能的神经调节靶点。
