UMR 1253, ibrain, Université de Tours, Inserm, 10 Boulevard Tonnellé, 37032, Tours, France.
CHRU de Tours, Tours, France.
J Neurol. 2022 Jul;269(7):3443-3460. doi: 10.1007/s00415-022-11002-4. Epub 2022 Mar 6.
The role of the trigeminal system in facial and dural sensitivity has been recognized for a long time. More recently, the trigeminal system has also been considered a prominent actor in brain nociceptive innervation. It is the anatomical substrate of several frequent conditions, such as primary or secondary headaches, trigeminal neuralgia, and other orofacial pains. Appreciation of the delicate anatomical arrangement of the trigeminal pathway is one of the keys to understanding these conditions' pathophysiology and to proposing innovative treatments. This review provides a structured presentation of existing knowledge about the trigeminal system, from classical anatomical data to the most recent literature. First, we present the organization of the trigeminal pathway from the trigeminal divisions, nerve, and nuclei to the thalamus and somatosensory cortex. We describe the neurons and fibers' repartition at each level, depending on the location (somatotopic organization) and the type of receptors (modal organization). Such a dual somatotopic-modal arrangement of the trigeminal fibers is especially clear for the juxtapontine segment of the trigeminal nerve and the trigeminal nuclei of the brainstem. It has significant clinical consequences both for diagnosis and treatment. Second, we explore how the trigeminal system is modulated and involved in reflexes, for instance the trigemino-cardiac and the trigemino-autonomic reflexes, which could play an essential role in the autonomic symptoms observed in cluster headache. Finally, we present how to interact with this complex system to relieve pain mediated by the trigeminal system. This section covers both neuromodulatory and lesional approaches.
三叉神经系统对面部和硬脑膜敏感性的作用早已被人们所认识。最近，三叉神经系统也被认为是大脑伤害性传入神经的重要组成部分。它是几种常见疾病的解剖学基础，如原发性或继发性头痛、三叉神经痛和其他口腔面部疼痛。了解三叉神经通路的精细解剖结构是理解这些疾病病理生理学和提出创新治疗方法的关键之一。这篇综述从经典解剖学数据到最新文献，对三叉神经系统的现有知识进行了结构化介绍。首先，我们介绍了三叉神经通路从三叉神经分支、神经和核到丘脑和体感皮层的组织。我们描述了每个水平的神经元和纤维的分布，这取决于位置（体感觉组织）和受体类型（模态组织）。三叉神经纤维的这种双重体感觉-模态排列在三叉神经根的桥脑旁节段和脑干的三叉神经核中尤为明显。它对诊断和治疗都有重要的临床意义。其次，我们探讨了三叉神经系统是如何被调节和参与反射的，例如三叉神经-心脏反射和三叉神经-自主反射，这些反射可能在丛集性头痛中观察到的自主症状中发挥重要作用。最后，我们介绍了如何与这个复杂的系统相互作用，以缓解三叉神经系统介导的疼痛。这部分包括神经调节和病变的方法。
