Chen Fenyang, Zhang Zhiliang, Miao Jianliang, Zhang Yvting, Wang Ding, Yan Juncheng, Pan Lei, Ye Haiqi, Ding Zhongxiang, Ge Xiuhong
Department of Medical Imaging, Section One of Air Force Hangzhou Special Crew Sanatorium of PLA AIR Force, Hangzhou, 310013, China.
Department of Radiology, Zhejiang Hospital, Hangzhou, China.
BMC Med Imaging. 2025 Jul 1;25(1):222. doi: 10.1186/s12880-025-01801-2.
To investigate whether dysfunction of the glymphatic system and altered neurofluidic dynamics contribute to the pathophysiology of classical trigeminal neuralgia (CTN), and to explore the potential interplay between brain-CSF coupling and structural brain changes.
A total of 131 patients with CTN and 106 age- and sex-matched healthy controls were recruited. All participants underwent multimodal MRI, including high-resolution structural imaging, resting-state functional MRI, and diffusion tensor imaging. Key indices included choroid plexus (CP) volume as a proxy for CSF production, global BOLD-CSF coupling as a measure of functional neurofluidic interaction, and the DTI-based ALPS index reflecting glymphatic clearance. Additional markers included peak width of skeletonized mean diffusivity (PSMD) and global gray/white matter and CSF volume. Partial correlation analyses were performed between imaging metrics and clinical assessments.
CTN patients showed significantly increased CP volume (P = 0.022) and gBOLD-CSF coupling (P < 0.001), along with reduced bilateral ALPS indices (P = 0.002, P = 0.004). PSMD and CSF volume were elevated (P < 0.001, P < 0.001), while gray and white matter volumes were reduced (P = 0.028, P = 0.009). gBOLD-CSF coupling correlated positively with depression, anxiety, and pain-related disability scores (P < 0.001), and negatively with MMSE (P = 0.022).
This study provides multimodal MRI evidence of glymphatic dysfunction and neurofluidic alterations in CTN, supporting a conceptual framework in which disrupted brain-CSF interaction may influence peripheral sensory modulation through a putative brain-CSF-ganglion pathway. These results may inform mechanistic hypotheses and guide future research on the neurofluidic underpinnings of neuropathic pain, potentially providing new insights into the pathogenesis of CTN.
研究类淋巴系统功能障碍和神经流体动力学改变是否促成原发性三叉神经痛（CTN）的病理生理学，并探讨脑-脑脊液耦合与脑结构变化之间的潜在相互作用。
共招募了131例CTN患者和106例年龄及性别匹配的健康对照者。所有参与者均接受了多模态磁共振成像检查，包括高分辨率结构成像、静息态功能磁共振成像和扩散张量成像。关键指标包括作为脑脊液生成指标的脉络丛（CP）体积、作为功能性神经流体相互作用指标的全脑BOLD-脑脊液耦合，以及反映类淋巴系统清除功能的基于扩散张量成像的ALPS指数。其他标志物包括骨架化平均扩散率的峰宽（PSMD）以及全脑灰质/白质和脑脊液体积。对成像指标与临床评估进行偏相关分析。
CTN患者的CP体积（P = 0.022）和全脑BOLD-脑脊液耦合（P < 0.001）显著增加，同时双侧ALPS指数降低（P = 0.002，P = 0.004）。PSMD和脑脊液体积升高（P < 0.001，P < 0.001），而灰质和白质体积减少（P = 0.028，P = 0.009）。全脑BOLD-脑脊液耦合与抑郁、焦虑和疼痛相关残疾评分呈正相关（P < 0.001），与简易精神状态检查表（MMSE）呈负相关（P = 0.022）。
本研究提供了CTN中类淋巴系统功能障碍和神经流体改变的多模态磁共振成像证据，支持了一个概念框架，即脑-脑脊液相互作用的破坏可能通过假定的脑-脑脊液-神经节途径影响外周感觉调制。这些结果可能为机制假说提供信息，并指导未来关于神经性疼痛的神经流体基础的研究，可能为CTN的发病机制提供新的见解。
