Zhang Yan, Wang Xueju, Wang Xuefeng, Huang Gengdi
State Key Laboratory of Common Mechanism Research for Major Diseases, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China.
Neuroscience Center, Chinese Academy of Medical Sciences, Beijing, China.
Front Physiol. 2025 Aug 5;16:1633028. doi: 10.3389/fphys.2025.1633028. eCollection 2025.
Trigeminal neuralgia (TN) is a chronic neuropathic pain disorder characterized by spontaneous or triggered electric shock-like facial pain. Microvascular decompression (MVD) is the most effective surgical intervention for classical TN that is refractory to medication. Recent advances in neuroimaging have enhanced visualization of the trigeminal nerve's vascular anatomy, deepening insights into TN pathophysiology and paving the way for improved diagnostics and therapies. Resting-state functional magnetic resonance imaging (rs-fMRI) has been extensively applied in studies of TN, uncovering alterations in brain activity, functional connectivity, cortical thickness and neural networks.
Independent component analysis (ICA) presents a powerful alternative for analyzing fMRI data, offering several advantages over traditional region of interests (ROIs) approaches. The sensorimotor network playing a key role in pain modulation, identifying neuroimaging differences in the sensorimotor network is crucial for detecting and intervening in TN, Forty TN patients underwent MVD surgery, with follow-up assessments conducted 6 months postoperatively and twenty-five healthy controls (HC) were recruited and scanned with resting state fMRI (rs-fMRI). Group ICA was used to identify ROIs and assessed inter-group differences in neural activity using false discovery rate (FDR) correction.
Compared to the HC, increased activity was observed in the right frontal operculum cortex, right insular cortex, right inferior frontal gyrus (pars opercularis), and right frontal pole in TN patients. Conversely, decreased activity was found in the right cerebellum (lobule IX) and left cerebellum (lobules VIII and IX). Compared to the pre-surgery, increased activity was found in the right precentral gyrus in the post-surgery group. Compared to the HC, long-term increased activity was still present in the right frontal operculum cortex, right insular cortex, right inferior frontal gyrus (pars opercularis), and right frontal pole despite the effectiveness of MVD surgery. In contrast, MVD significantly reduced the area of aberrant activation regions, particularly in the operculo-insular cortex, and also normalized cerebellar abnormalities.
Our study demonstrates that ICA can effectively identify distinct patterns of functional connectivity in the sensorimotor network associated with TN and MVD surgery. These regions are involved in altered pain processing, including nociceptive stimulus integration, subjective pain perception, pain chronification, and pain-related empathy. Our findings suggest promising biomarkers for TN and provide insights for developing targeted treatments.
三叉神经痛（TN）是一种慢性神经性疼痛疾病，其特征为自发或触发的电击样面部疼痛。微血管减压术（MVD）是治疗对药物难治的典型TN最有效的手术干预方法。神经影像学的最新进展增强了对三叉神经血管解剖结构的可视化，加深了对TN病理生理学的理解，并为改进诊断和治疗方法铺平了道路。静息态功能磁共振成像（rs-fMRI）已广泛应用于TN研究，揭示了大脑活动、功能连接、皮质厚度和神经网络的改变。
独立成分分析（ICA）为分析功能磁共振成像数据提供了一种强大的替代方法，与传统的感兴趣区域（ROI）方法相比具有多个优势。感觉运动网络在疼痛调节中起关键作用，识别感觉运动网络中的神经影像学差异对于检测和干预TN至关重要。40例TN患者接受了MVD手术，术后6个月进行随访评估，并招募了25名健康对照（HC）进行静息态功能磁共振成像（rs-fMRI）扫描。使用组ICA识别ROI，并使用错误发现率（FDR）校正评估组间神经活动差异。
与HC相比，TN患者右侧额盖皮质、右侧岛叶皮质、右侧额下回（眶部）和右侧额极的活动增加。相反，在右侧小脑（小叶IX）和左侧小脑（小叶VIII和IX）发现活动减少。与术前相比，术后组右侧中央前回的活动增加。与HC相比，尽管MVD手术有效，但右侧额盖皮质、右侧岛叶皮质、右侧额下回（眶部）和右侧额极的活动长期增加。相比之下，MVD显著减少了异常激活区域的面积，尤其是在岛盖皮质，并使小脑异常恢复正常。
我们的研究表明，ICA可以有效地识别与TN和MVD手术相关的感觉运动网络中不同的功能连接模式。这些区域参与了疼痛处理的改变，包括伤害性刺激整合、主观疼痛感知、疼痛慢性化和疼痛相关的同理心。我们的发现为TN提供了有前景的生物标志物，并为开发靶向治疗提供了见解。
