Department of Neurosurgery, NIMHANS, Bengaluru, Karnataka, India.
Department of NeuroImaging and Interventional Radiology (NIIR), NIMHANS, Bengaluru, Karnataka, India.
Br J Neurosurg. 2024 Apr;38(2):327-331. doi: 10.1080/02688697.2021.1872769. Epub 2021 Jan 19.
Deafferentiation pain following brachial plexus root avulsion has been documented to be severe enough to affect activities of daily living in patients. Microsurgical DREZotomy is known to alleviate the symptoms by decreasing the afferent signals transmitted from the spinal cord to sensory cortex.
To document and analyse the effectiveness of DREZotomy and to evaluate the role of 'sensory cortex' in the cause and relief of dysesthetic pain, using fMRI.
This was a prospective study conducted between 2010 and 2016 and included all patients who underwent DREZotomy for dysesthetic pain following traumatic brachial plexus injury (TBPI). Patients were evaluated both preoperatively and postoperatively with Visual Analogue Scale(VAS), Hospital Anxiety and Depression score (HADS) and SF36 questionnaire and effectiveness of surgery was assessed. Functional magnetic resonance imaging (fMRI) of the brain in resting state was performed before and after surgery and was also compared with controls. Patients underwent standard microsurgical DREZotomy from C5 to D1. Postoperative assessment was done at 6 weeks and 6 months following surgery.
Our series had 18 patients aged between 22 and 63 years. RTA was the most common cause of injury. There was significant decrease in pain at 6 months follow up compared to pre-operative values as assessed by VAS, HADS, SF36 questionnaire. fMRI analysis revealed cluster activations in the sensory, motor cortex and in the right cingulate gyrus in the preoperative group which was higher than in normal controls. In the postoperative group, the size of the resting state activation was significantly reduced.
DREZotomy is an effective procedure for TBPI patients. We hypothesize that these fMRI findings reflect the cortical reorganization that occurs not only after injury but also following successful surgery which explains the cause and relief of dyesthetic pain.
臂丛神经根撕脱伤后的去分化痛严重到足以影响患者的日常生活活动。已知显微 DREZotomy 通过减少从脊髓传递到感觉皮层的传入信号来缓解症状。
通过 fMRI 记录和分析 DREZotomy 的有效性，并评估“感觉皮层”在引起和缓解感觉异常性疼痛中的作用。
这是一项前瞻性研究，于 2010 年至 2016 年进行，包括所有因创伤性臂丛神经损伤（TBPI）后感觉异常性疼痛而行 DREZotomy 的患者。患者在术前和术后均进行视觉模拟评分（VAS）、医院焦虑和抑郁评分（HADS）和 SF36 问卷评估，并评估手术效果。在手术前后进行静息状态下的大脑功能磁共振成像（fMRI），并与对照组进行比较。患者接受 C5 至 D1 的标准显微 DREZotomy。术后评估在手术后 6 周和 6 个月进行。
我们的系列研究有 18 例年龄在 22 至 63 岁之间的患者。RTA 是最常见的损伤原因。与术前相比，术后 6 个月的疼痛明显减轻，VAS、HADS、SF36 问卷评估结果显示。fMRI 分析显示术前组感觉皮层、运动皮层和右侧扣带回的簇激活高于正常对照组。术后组静息状态激活的大小显著减小。
DREZotomy 是治疗 TBPI 患者的有效方法。我们假设这些 fMRI 发现反映了不仅在受伤后而且在成功手术后发生的皮质重组，这解释了感觉异常性疼痛的原因和缓解。
