Gray and white matter abnormalities in primary trigeminal neuralgia with and without neurovascular compression
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(2020) 21:136
The Journal of Headache and Pain
RESEARCH ARTICLE
Open Access
Gray and white matter abnormalities in primary trigeminal neuralgia with and without neurovascular compression Min Wu1,2* , Xiaofeng Jiang1,2, Jun Qiu3, Xianming Fu1,2 and Chaoshi Niu1,2
Abstract Purpose: Previous researches have reported gray and white matter microalterations in primary trigeminal neuralgia (TN) with neurovascular compression (NVC). The central mechanism underlying TN without NVC are unknown but may include changes in specific brain regions or circuitries. This study aimed to investigate abnormalities in the gray matter (GM) and white matter (WM) of the whole brain and the possible pathogenetic mechanism underlying this disease. Methods: We analyzed brain morphologic images of TN patients, 23 with NVC (TN wNVC) and 22 without NVC (TN wNVC) compared with 45 healthy controls (HC). All subjects underwent 3T-magnetic resonance imaging and pain scale evaluation. Voxel-based morphometry (VBM) and surface-based morphometry (SBM) were used to investigate whole brain grey matter quantitatively; graph theory was applied to obtain network measures based on extracted DTI data based on DTI data of the whole brains. Sensory and affective pain rating indices were assessed using the visual analog scale (VAS) and short-form McGill Pain Questionnaire (SF-MPQ). Results: The VBM and SBM analyses revealed widespread decreases in GM volume and cortical thickness in TN wNVC compared to TN woNVC, and diffusion metrics measures and topology organization changes revealed DTI showed extensive WM integrity alterations. However, above structural changes differed between TN wNVC and TN woNVC, and were related to specific chronic pain modulation mechanism. Conclusion: Abnormalities in characteristic regions of GM and WM structural network were found in TN woNVC compared with TN wNVC group, suggesting differences in pathophysiology of two types of TN. Keywords: Trigeminal neuralgia, Voxel-based morphometry, Surface-based morphometry, Diffusion tensor imaging, Internal neurolysis, Neurovascular compression, Conditioned pain modulation
Introduction Trigeminal neuralgia (TN), one of the most common pain conditions affect the craniofacial region, involves abnormalities in the peripheral and central trigeminal sensory pathways. The essential role of neurovascular * Correspondence: [email protected] 1 Department of Neurosurgery, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, P.R. China 2 Anhui Provincial Stereotactic Neurosurgical Institute, Hefei, Anhui 230001, P.R. China Full list of author information is available at the end of the article
compression (NVC) in classical TN pathophysiology has been supported by the efficiency of microvascular decompression (MVD) in treating classical TN since 1960s [1], and the NVC has been considered as “target” for the treatment of TN with NVC (TN wNVC) [2]. Accumulating evidence suggests th
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