多模态磁共振对原发性三叉神经痛患者脑结构和功能改变的研究

doi:10.19854/j.cnki.1008-2425.2023.06.0002

摘要/Abstract

摘要： 目的利用多模态磁共振技术研究原发性三叉神经痛(PTN)患者脑结构与功能改变的特点,进一步探究PTN的病理机制,筛选PTN潜在的治疗靶点。方法对22例PTN患者及20例健康者行T1WI高分辨率MRI扫描及静息态功能MRI扫描,首先进行基于体素的形态学分析,得出患者较健康者脑灰质体积(GMV)存在差异的脑区,再将灰质体积存在变化的脑区作为兴趣区设立种子点,明确两组间功能具有明显差异的脑区链接。结果与健康对照组相比,PTN患者组脑灰质总体积减小,脑灰质结构中,PTN患者的左侧前扣带回(ACC)、右侧中央后回、右侧颞中回、左侧海马体、左侧颞上回的GMV较健康对照组减少;患者左侧ACC的GMV与病程呈负相关。同时PTN患者左侧ACC与右侧额下回、左侧岛叶、右侧小脑Crus Ⅱ区的功能链接较健康者增强。结论 ACC是PTN中枢神经系统相关病理机制中的重要一环,同时ACC可能是PTN的潜在治疗靶点。

关键词: 原发性三叉神经痛, 磁共振成像, 病理机制

Abstract: Objective The objective of this study was to study the abnormal changes in brain structure and function in patients with primary trigeminal neuralgia (PTN) by using multimodal magnetic resonance technology,to further explore the pathological mechanisms of PTN,and to identify potential therapeutic targets for PTN.Methods T1WI high-resolution MRI scans and resting-state functional MRI scans were performed on 22 PTN patients and 20 healthy individuals.Brain areas where there were differences in brain grey matter volume(GMV)between patients and healthy individuals was identifide by using voxel-based morphological analysis.The brain regions with variations in GMV were used as areas of interest to establish seed points and to detected brain links with significantly different functional connetivity between the two groups.Results Compared to healthy controls,the total GMV was reduced in the PTN patient group.Among the grey matter structures,the GMV of the left anterior cingulate gyrus (ACC),right postcentral gyrus,right middle temporal gyrus,left hippocampus,and left superior temporal gyrus were reduced in PTN patients compared to healthy controls,while the GMV of the patient's left ACC was negatively correlated with the course of the disease.The functional links between the left ACC and the right inferior frontal gyrus,the left insula,and the right cerebellar Crus II area were also enhanced in PTN patients compared to healthy subjects.Conclusion ACC is an important part of the pathological mechanism associated with the central nervous system of PTN,while ACC may be a potential therapeutic target for PTN.

Key words: Primary trigeminal neuralgia, Pathological mechanism, Magnetic Resonance Imaging

中图分类号:

R742.2

张姝凤, 尹然, 何占彪, 王雅迪, 王宏伟. 多模态磁共振对原发性三叉神经痛患者脑结构和功能改变的研究[J]. 立体定向和功能性神经外科杂志, 2023, 36(6): 327-333.

Zhang Shufeng, Yin Ran, He ZhanBiao, et al. Multimodal magnetic resonance study of structural and functional brain alterations in patients with primary trigeminal neuralgia.[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2023, 36(6): 327-333.

参考文献

[1] Tubbs RS,Mortazavi MM,Krishnamurthy S,et al.The relationship between the superior petrosal sinus and the porus trigeminus:an anatomical study.J Neurosurg,2013,119(5):12215.
[2] 张书光,刘梦龙,位振清.原发性三叉神经痛的治疗现状[J].中国临床神经外科杂志,2022,27(11):940~942.
[3] Kerr FW.Evidence for a peripheral etiology of trigeminal neuralgia[J].J Neurosurg,2007,107 (1):225~231.
[4] Apkarian AV,Sosa Y,Sonty S,et al.Chronic back pain is associated with decreased prefrontal and thalamic gray matter density[J].J Neurosci,2004,24(46):10410~10415.
[5] Kuchinad A,Schweinhardt P,Seminowicz DA,et al.Accelerated brain gray matter loss in fibromyalgia patients:premature aging of the brain[J].J Neurosci,2007,27(15):4004~4007.
[6] May A.Chronischer schmerz verändert die struktur des gehirns[J].Schmerz, 2009,23(6):569~575.
[7] Zhang P,Jiang Y,Liu J,etal.Altered brain functional network dynamics in classic trigeminal neuralgia:a resting-state functional magnetic resonance imaging study[J].J Headache Pain,2021,22(1):147~149.
[8] Xu H,Seminowicz DA,Krimmel SR,etal.Altered Structural and Functional Connectivity of Salience Network in Patients with classic trigeminal neuralgia[J].J Pain,2022,23(8):1389~1399.
[9] Osaka N,Osaka M,Morishita M,et al.A word expressing affective pain activates the anterior cingulate cortex in the human brain:an fMRI study[J].Behav Brain Res,2004,153(1):123~127.
[10] Rolls ET.The cingulate cortex and limbic systems for emotion,action,and memory[J].Brain Struct Funct,2019,224(9):3001~3018.
[11] Obermann M,Rodriguez-Raecke R,Naegel S,et al.Gray matter volume reduction reflects chronic pain in trigeminal neuralgia[J].Neuroimage,2013,74:352~358.
[12] Kuo CC,Chiou RJ,Liang KC,et al.Differential involvement of the anterior cingulate and primary sensorimotor cortices in sensory and affective functions of pain[J].J Neurophysiol,2009,101(3):1201~1210.
[13] Knierim JJ.The hippocampus[J].Curr Biol,2015,25(23):R1116~R1121.
[14] Vincent MB,Hadjikhani N.Migraine aura and related phenomena:beyond scotomata and scintillations[J].Cephalalgia,2007,27(12):1368~1377.
[15] Wang Y,Yang Q,Cao D,et al.Correlation between nerve atrophy,brain grey matter volume and pain severity in patients with primary trigeminal neuralgia[J].Cephalalgia,2019,39(4):515~525.
[16] Vaculik MF,Noorani A,Hung PS,et al.Selective hippocampal subfield volume reductions in classic trigeminal neuralgia[J].Neuroimage,2019,23:101911.
[17] Kropf E,Syan SK,Minuzzi L,et al.From anatomy to function:the role of the somatosensory cortex in emotional regulation[J].Braz J Psychiatry,2019,41(3):261~269.
[18] Menon V,Uddin LQ.Saliency,switching,attention and control:a network model of INSula function[J].Brain Struct Funct,2010 ,214(5-6):655~667.
[19] Moisset X,Villain N,Ducreux D,et al.Functional brain imaging of trigeminal neuralgia[J].Eur J Pain,2011,15(2):124~131.
[20] Dolcos F,Kragel P,Wang L,et al.Role of the inferior frontal cortex in coping with distracting emotions[J].Neuroreport.2006 ,17(15):1591~1594.
[21] Gracely RH,Geisser ME,Giesecke T,et al.Pain catastrophizing and neural responses to pain among persons with fibromyalgia[J].Brain,2004,127(4):835~843.
[22] Hu Y,Dolcos S.Trait anxiety mediates the link between inferior frontal cortex volume and negative affective bias in healthy adults[J].Soc Cogn Affect Neurosci,2017,12(5):775~782.
[23] Liu S,Shu H,Crawford J,etal.Optogenetic Activation of Dopamine Receptor D1 and D2 Neurons in Anterior Cingulate Cortex Differentially Modulates Trigeminal Neuropathic Pain[J].Mol Neurobiol,2020,57(10):4060~4068.
[24] Koziol LF,Budding D,Andreasen N,et al.Consensus paper:the cerebellum's role in movement and cognition[J].Cerebellum,2014,13(1):151~177.
[25] Strata P.The emotional cerebellum.Cerebellum[J].2015,14(5):570~177.
[26] Borsook D,Moulton EA,Pendse G,et al.Comparison of evoked vs.spontaneous tics in a patient with trigeminal neuralgia (tic doloureux)[J].Mol Pain,2007,3:34.
[27] Moulton EA,Schmahmann JD,Becerra L,et al.The cerebellum and pain:passive integrator or active participator[J] Brain Res Rev,2010,65(1):14~27.