Retrograde sensory ganglionectomy for control of intractable pain

我们早期的研究表明，当神经内注射到周围神经时，一些神经毒素可以逆行运输到它们的亲代感觉神经元。因此，吸收了毒素的感觉神经元发生了退化。利用这一现象，我们开展了一项研究，将合适的神经毒素注射到神经中，可以选择性地切除背根神经节或三叉神经节中的特定感觉细胞群，从而作为控制疼痛的一种方式。在研究的多种神经毒素中，我们发现阿霉素（阿霉素，ADM）在这方面特别有用，因为ADM具有适当的自身荧光，使我们能够在注射时定位ADM的途径和目的地。在猫三叉神经分支神经内注射ADM后12小时内，ADM在三叉神经节细胞中以地形组织的方式被证实。在几天内，这些神经元接受了更多的ADM，发生了选择性变性。进入脑干三叉神经复合体的初级传入神经可以通过Fink-Helmer法追溯到三叉神经脊髓核。三叉神经短潜伏期感觉诱发电位（SSEP）显示，注射ADM后24-48小时，三叉神经的整个波形消失。SSEP一旦丢失就再也无法恢复。根据这些基本资料，我们对3例顽固性神经痛综合征患者进行了ADM神经节切除术。2例为带状疱疹后神经痛，3例为三叉神经痛失败的各种尝试。这些患者对ADM神经节切除术反应良好。第一，完全消除疼痛，第二，50%，第三，70%的缓解。2例患者在ADM神经节切除术后仍有部分疼痛，部分原因是单次注射未完全去神经的疼痛范围更广。这种新的疼痛控制方法可用于神经痛综合征的脱神经递质，如带状疱疹后神经痛，幻肢痛，疼痛由于癌症侵入神经。少

Our earlier studies indicated that several neurotoxins could be retrogradely transported to their parental sensory neurons when intraneurally injected into the peripheral nerve. Consequently, sensory neurons having taken up the toxin underwent degeneration. Utilizing this phenomenon, we initiated a study in which suitable neurotoxins when injected into the nerve may selectively gangliotomize the particular groups of sensory cells in the dorsal root ganglia or trigeminal ganglia and thus serve as a way of controlling pain.Among more than several neurotoxins studied, we found doxorubicin(Adriamycin, ADM) is in particular useful for this purpose since ADM has its proper autofluorescence which enabled us to localize the route and destination of ADM when injected. Within 12 hrs after intraneural injection of ADM into the cat's trigeminal nerve branches, ADM was demonstrated in the trigeminal ganglion cells in a topographically organized manner. Within several days, these neurons having take … More n up ADM underwent selective degeneration. The primary afferents entering into the brainstem trigeminal complex could be traced upt to the spinal trigeminal nucleus by the Fink-Helmer method. The short latency sensory evoked potential (SSEP) of the trigeminal nerve disclosed the abolishment of the entire waveforms 24-48 hrs after the injection of ADM into the corresponding nerve. The SSEP never recovered when once lost.Following these basic data, we initiated the ADM ganglionectomy to three selected patients with intractable neuralgic pain syndrome. Two with postherpetic neuralgia and the third with failed trigeminal neuralgia to a variety of attempts. These patients responded favorably to ADM ganglionectomy. One, complete abolishment of pain, the second, 50 % and the third 70 % relief. Some remaining pain after ADM ganglionectomy in two patients was in part explained by the wider extent of pain which was not totally denervaied by a single injection. This novel method of pain control may be utilized for neuralgic pain syndromes of deafferentation in nature such as postherpetic neuralgia, phantom limb pain, and pain due to cancer invasion into the nerves. Less