PATHOLOGICAL FINDINGS ASSOCIATED WITH TRIGEMINAL NEURALGIA CAUSED BY VASCULAR COMPRESSION
PATHOLOGICAL FINDINGS ASSOCIATED WITH TRIGEMINAL NEURALGIA CAUSED BY VASCULAR COMPRESSION
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DOI：
10.1227/00006123-199408000-00017
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发表时间：
1994-08-01
期刊：
影响因子：
4.8
通讯作者：
COAKHAM, HB
中科院分区：
文献类型：
--
作者：
HILTON, DA;LOVE, S;COAKHAM, HB
血管压迫三叉神经根占难治性三叉神经痛病例的80%以上，但其发病机制仍有争议。作者报告了1例三叉神经痛患者三叉神经根被巨大的内侧岩静脉压迫时的超微结构变化，并与6例与血管压迫无关的三叉神经痛的结果进行了比较。三叉神经根的血管压迫与髓鞘局灶性丢失和脱髓鞘轴突的紧密贴壁相关，很少有星形胶质细胞突起介入。不存在炎性细胞。免疫电镜检查证实胶质细胞酸性蛋白的星形胶质细胞进程主要局限于病变的周边。在其他六个神经根切断术标本中，只有一个，来自多发性硬化症患者，表现出脱髓鞘与干预星形胶质细胞过程，血管周围淋巴细胞，和脂质负载的巨噬细胞。这些发现支持了三叉神经痛的发病机制与血管压迫有关的假说。
VASCULAR COMPRESSION OF the trigeminal nerve root accounts for more than 80% of intractable cases of trigeminal neuralgia, but the pathogenesis is still debated. The authors report the ultrastructural changes in the trigeminal nerve root of a patient with trigeminal neuralgia, at the point of compression by a large, medially placed petrosal vein, and compare these with the findings in six cases of trigeminal neuralgia not related to vascular compression. Vascular compression of the trigeminal nerve root was associated with focal loss of myelin and close apposition of the demyelinated axons with few intervening astrocytic processes. No inflammatory cells were present. Immunoelectron microscopy for glial fibrillary acid protein confirmed that astrocyte processes were largely confined to the periphery of the lesion. Of the other six rhizotomy specimens, only one, from a patient with multiple sclerosis, showed demyelination with intervening astrocyte processes, perivascular lymphocytes, and lipid-laden macrophages. These findings support the hypothesis that ephaptic transmission plays a role in the pathogenesis of trigeminal neuralgia related to vascular compression.