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，几种神经毒素可以逆行运输到它们的父母感觉神经元。因此，摄取了毒素的感觉神经元经历了退化。利用这一现象，我们启动了一项研究，即当适当的神经毒素注射到神经中时，可以选择性地切断背根神经节或三叉神经节中特定的感觉细胞群，从而作为一种控制疼痛的方法。在几种已研究的神经毒素中，我们发现阿霉素(ADM)对此特别有用，因为ADM具有合适的自身荧光，使我们能够在注射时定位ADM的路线和目的地。将ADM注入猫三叉神经支后12小时内，ADM在三叉神经节细胞内呈局部有序分布。在几天内，这些神经元接受了…更多的N-UP ADM发生选择性退变。用Fink-Helmer法可将进入脑干三叉神经复合体的初级传入追踪至三叉神经脊束核。三叉神经短潜伏期感觉诱发电位(SSEP)显示，注射ADM后24~48h，整个波形消失。根据这些基本数据，我们选择了3例顽固性神经痛综合征患者行ADM神经节切除术。两人患有带状疱疹后神经痛，第三人三叉神经痛失败，各种尝试。这些患者对ADM神经节切除术反应良好。第一，彻底消除痛苦，第二，50%，第三，70%的缓解。两名患者在ADM神经节切除术后仍有一些疼痛，部分原因是疼痛范围更广，但单次注射并未完全消除疼痛。这种新的疼痛控制方法可用于自然界中去传入的神经痛性疼痛综合征，如带状疱疹后神经痛、幻肢痛和因癌症侵入神经而引起的疼痛。较少

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