Rappaport Z H, Govrin-Lippmann R, Devor M
Department of Neurosurgery, Rabin Medical Center, Petah Tiqva, Israel.
Stereotact Funct Neurosurg. 1997;68(1-4 Pt 1):182-6. doi: 10.1159/000099920.
During surgical exposure of the trigeminal root for the treatment of trigeminal neuralgia, biopsy specimens of the nerve root were taken in 12 consecutive patients. The biopsies were taken from areas as close as possible to the site of vascular compression, when present. The tissue was prepared for electron-microscopic evaluation. Except for 1 case, massive disruption of tissue ultrastructure was observed. The major findings included zones of de- and dysmyelination, juxtaposition of denuded axons, apparent axon loss and degeneration, and collagen deposition. Adjacent areas of normal root structure were present in most specimens. The ultrastructural changes observed in the biopsy samples demonstrate important pathology within the trigeminal root. Dysmyelination and the proximity of denuded axons in close apposition to each other support neurophysiological theories of pain production including ectopic electrogenesis, ephaptic contacts, and crossed after-discharge. The findings in this study demonstrate a pathophysiological basis for the syndrome of trigeminal neuralgia.
在为治疗三叉神经痛而进行三叉神经根手术暴露过程中，连续12例患者的神经根均获取了活检标本。活检取材部位尽可能靠近存在血管压迫的部位（若有血管压迫）。组织经处理后用于电镜评估。除1例病例外，均观察到组织超微结构的大量破坏。主要发现包括脱髓鞘和髓鞘发育异常区域、裸露轴突并列、明显的轴突丢失和退变以及胶原沉积。大多数标本中存在相邻的正常根结构区域。活检样本中观察到的超微结构变化表明三叉神经根内存在重要病理改变。髓鞘发育异常以及彼此紧邻的裸露轴突支持了包括异位电活动、ephaptic接触和交叉后放电在内的疼痛产生的神经生理学理论。本研究结果证明了三叉神经痛综合征的病理生理基础。
