Mechanism of trigeminal neuralgia: an ultrastructural analysis of trigeminal root specimens obtained during microvascular decompression surgery

Devor, Marshall; Govrin-Lippmann, Ruth; Rappaport, Z. H.

doi:10.3171/jns.2002.96.3.0532

Cited by 251 publications

(152 citation statements)

References 64 publications

Supporting

Mentioning

135

Contrasting

Unclassified

Order By: Relevance

“…However, analysis of anatomical and clinical data supports our concept that at the level of the brainstem, when leaving the trigeminal root, specifically at the REZ, the sensory fibers change their direction to target their proper nuclei in the trigeminal brainstem nuclear sensory complex (TBNSC) (Crissman et al, 1996;Pajot et al, 2000;Devor et al, 2002b;Sindou et al, 2002Sindou et al, , 2006Miller et al, 2009). Consequently, many of the Aβ fibers transmitting tactile information from the orofacial region leave the trigeminal root rostrally in their trajectory to the main sensory nucleus, located at the level of the midpons (Samii and Jannetta, 1981;Sessle, 2000) (Fig.…”

mentioning

confidence: 94%

The Role of Sensory Fiber Demography in Trigeminal and Postherpetic Neuralgias

DaSilva

DosSantos

2011

J Dent Res

View full text Add to dashboard Cite

A supplemental appendix to this article is published electronically only at http://jdr.sagepub.com/supplemental. AbstrActIn this study, we systematically investigated fiber demography, based on function and distribution, from the periphery to their destinations in the various central (sub) nuclei in the trigeminal brainstem nuclear sensory complex. Conventional and novel compelling information is provided, demonstrating that the ratio and somatotopy of types A and C sensory fibers at the site of a lesion can elucidate important puzzles in TNP disorders. For instance, we explain how of a major shift in the fibers' direction and ratio at the level of the trigeminal root entry zone (REZ) influences the pathophysiology of preand typical trigeminal neuralgia. As a result, there is a high A/C ratio of oral and peri-oral fibers in the supero-medial region of the REZ, which is mostly susceptible to vascular compression. However, this A/C ratio varies considerably at lower proportions in other areas along the peripheral trigeminal pathway, where an injury (viral, vessel compression, or trauma) can lead to a broader spectrum of fiber involvement and, consequently, pain outcome. In summary, we explain how fiber demography can influence pain quality, location, temporal features, progress, and treatment prognosis of TNP in those patients who develop it.

show abstract

mentioning

confidence: 94%

The Role of Sensory Fiber Demography in Trigeminal and Postherpetic Neuralgias

DaSilva

DosSantos

2011

J Dent Res

View full text Add to dashboard Cite

show abstract

“…There have been multiple demonstrations of ephaptic interactions that can lead to ectopic impulse activity, not only between closely apposed uninjured axons (56) but also between injured axons (57,58) and between neighboring dysmyelinated axons (59). It has been suggested that demyelination due to compression is present in some cases of trigeminal neuralgia (2,60,61). It is well established that myelinated axons can produce large external electrical fields in regions where myelin is focally absent (62).…”

Section: Acknowledgmentsmentioning

confidence: 99%

“…Its pathophysiology has been modeled by the "ignition theory" (11,12), which posits that injured trigeminal neurons fire spontaneously and have a lower threshold for evoked afterdischarges leading to paroxysmal pain. Intraoperative microneurographic recordings in trigeminal nerve fibers after stimulation of the known trigger zone in a TN patient demonstrated afterdischarges that were absent when unaffected facial areas were stimulated (13), loss, demyelination and dysmyelination consistent with NVC of the trigeminal nerve (2). However, recent studies have suggested that only severe neurovascular contact, causing displacement or atrophy of the nerve, is associated with pain in classical TN (3,4), and some studies have questioned whether NVC is necessary and sufficient for TN, since pain can occur and recur in the absence of nerve compression (5,6).…”

mentioning

confidence: 99%

A Gain-of-Function Mutation in Nav1.6 in a Case of Trigeminal Neuralgia

Tanaka¹,

Zhao²,

Dib-Hajj³

et al. 2016

Mol Med

110

View full text Add to dashboard Cite

“…Morphological changes in the nerve include nerve deviation, distortion, groove formation, and atrophy. 5 Atrophy of the nerve is seen in most cases of TN 20 and is probably attributable to structural abnormalities such as axonal loss and demyelination, 4,10,12,18 but these morphological changes are difficult to describe objectively. Object.…”

mentioning

confidence: 99%

Atrophic changes in the trigeminal nerves of patients with trigeminal neuralgia due to neurovascular compression and their association with the severity of compression and clinical outcomes

Leal¹,

Barbier

Hermier

et al. 2014

JNS

108

View full text Add to dashboard Cite

S trong evidence suggests that in classic trigeminal neuralgia (TN) caused by neurovascular compression (NVC), the neuralgia is related to morphological and structural changes in the trigeminal nerve (TGN) that are probably the result of chronic vascular compression. Morphological changes in the nerve include nerve deviation, distortion, groove formation, and atrophy. 5 Atrophy of the nerve is seen in most cases of TN 20 and is probably attributable to structural abnormalities such as axonal loss and demyelination, 4,10,12,18 but these morphological changes are difficult to describe objectively. Object. The aim of this study was to prospectively evaluate atrophic changes in trigeminal nerves (TGNs) using measurements of volume (V) and cross-sectional area (CSA) from high-resolution 3-T MR images obtained in patients with unilateral trigeminal neuralgia (TN), and to correlate these data with patient and neurovascular compression (NVC) characteristics and with clinical outcomes.Methods. Anatomical TGN parameters (V and CSA) were obtained in 50 patients (30 women and 20 men; mean age 56.42 years, range 22-79 years) with classic TN before treatment with microvascular decompression (MVD). Parameters were compared between the symptomatic (ipsilateralTN) and asymptomatic (contralateralTN) sides of the face. Twenty normal control subjects were also included. Two independent observers blinded to the side of pain separately analyzed the images. Measurements of V (from the pons to the entrance of the nerve into Meckel's cave) and CSA (at 5 mm from the entry of the TGN into the pons) for each TGN were performed using imaging software and axial and coronal projections, respectively. These data were correlated with patient characteristics (age, duration of symptoms before MVD, side of pain, sex, and area of pain distribution), NVC characteristics (type of vessel involved in NVC, location of compression along the nerve, site of compression around the circumference of the root, and degree of compression), and clinical outcomes at the 2-year follow-up after surgery. Comparisons were made using Bonferroni's test. Interobserver variability was assessed using the Pearson correlation coefficient.Results. The mean V of the TGN on the ipsilateralTN (60.35 ± 21.74 mm 3 ) was significantly smaller (p < 0.05) than those for the contralateralTN and controls (78.62 ± 24.62 mm 3 and 89.09 ± 14.72 mm 3 , respectively). The mean CSA of the TGN on the ipsilateralTN (4.17 ± 1.74 mm 2 ) was significantly smaller than those for the contralateralTN and controls (5.41 ± 1.89 mm 2 and 5.64 ± 0.85 mm 2 , respectively). The ipsilateralTN with NVC Grade III (marked indentation) had a significantly smaller mean V than the ipsilateralTN with NVC Grade I (mere contact), although it was not significantly smaller than that of the ipsilateralTN with NVC Grade II (displacement or distortion of root). The ipsilateralTN with NVC Grade III had a significantly smaller mean CSA than the ipsilateralTN with NVC Grades I and II (p < 0.05). The TGN on the ipsilateralT...

show abstract

Mechanism of trigeminal neuralgia: an ultrastructural analysis of trigeminal root specimens obtained during microvascular decompression surgery

Cited by 251 publications

References 64 publications

The Role of Sensory Fiber Demography in Trigeminal and Postherpetic Neuralgias

The Role of Sensory Fiber Demography in Trigeminal and Postherpetic Neuralgias

A Gain-of-Function Mutation in Nav1.6 in a Case of Trigeminal Neuralgia

Atrophic changes in the trigeminal nerves of patients with trigeminal neuralgia due to neurovascular compression and their association with the severity of compression and clinical outcomes

Contact Info

Product

Resources

About