三叉神经痛合并根区蛛网膜粘连的病毒病因学研究

Objective To assess the relationship that trigeminal neuralgia combining arachnoids' adhesions and herpes simplex virus type 1. Methods There are fifty nine patients with trigeminal neuralgia their trigeminal nerve root area combined arachnoids' adhesion, cutting their arachnoids as the experimental group. There are twenty four patients with trigeminal neuralgia their trigeminal nerve root area is not combined significant arachnoids' adhesion, cutting their arachnoids as the case - control group. Using polymerase chain reaction and Western blot technique to detecting the HSV - 1 specific DNA fragments and specific antigen,and cutting twenty arachnoids of the patients with Brain Trauma as the normal control group. Results The positive ratio of DNA fragments in the three group is 69% 、58% and 25% respectively. The positive ratio of DNA fragments in the experiment group and case -control group were higher than the normal control group,with statistical difference ( P ＜ 0. 05 ), but the experimental group and case -control group compared with no significant difference ( P ＞ 0. 05 ). The positive ratio of virus - specific antigen is 51%、 25 % and 15 %respectively. The positive ratio of virus - specific antigen was higher than the case - control group, also higher than the normal control group, were significantly different ( P ＜ 0. 05 ), while the case - control group and the normal control group compared with no significant differences ( P ＞ 0. 05 ). Conclusion HSV - 1 proliferating infected patients with trigeminal neuralgia may result in the arachnoids adhesion of trigeminal nerve root zone; arachnoids tissue may be another latent base of HSV - 1; HSV - 1 infection may be another pathogenic factor of trigeminal neuralgia.     

三叉神经痛合并根区蛛网膜粘连的病毒病因学研究

Objective To assess the relationship that trigeminal neuralgia combining arachnoids' adhesions and herpes simplex virus type 1. Methods There are fifty nine patients with trigeminal neuralgia their trigeminal nerve root area combined arachnoids' adhesion, cutting their arachnoids as the experimental group. There are twenty four patients with trigeminal neuralgia their trigeminal nerve root area is not combined significant arachnoids' adhesion, cutting their arachnoids as the case - control group. Using polymerase chain reaction and Western blot technique to detecting the HSV - 1 specific DNA fragments and specific antigen,and cutting twenty arachnoids of the patients with Brain Trauma as the normal control group. Results The positive ratio of DNA fragments in the three group is 69% 、58% and 25% respectively. The positive ratio of DNA fragments in the experiment group and case -control group were higher than the normal control group,with statistical difference ( P ＜ 0. 05 ), but the experimental group and case -control group compared with no significant difference ( P ＞ 0. 05 ). The positive ratio of virus - specific antigen is 51%、 25 % and 15 %respectively. The positive ratio of virus - specific antigen was higher than the case - control group, also higher than the normal control group, were significantly different ( P ＜ 0. 05 ), while the case - control group and the normal control group compared with no significant differences ( P ＞ 0. 05 ). Conclusion HSV - 1 proliferating infected patients with trigeminal neuralgia may result in the arachnoids adhesion of trigeminal nerve root zone; arachnoids tissue may be another latent base of HSV - 1; HSV - 1 infection may be another pathogenic factor of trigeminal neuralgia.     

Change in sleep construction and its clinical significance in patients with epilepsy

ObjectiveAnalyzing change of sleep construction and its clinical significance in patients with epilepsy Methods The 24h ambulatory EEGs(AEEG) during interictal were monitored in 58 patients with epilepsy and control group (58 normal persons). Results 1. The sleep period tiae and time of REM (rapid eye movement sleep)were no marked difference between the epilepsy and control groups, 479.98±67. 4 min in epilepsy, 496. 33±57.62 min in control. 2. In coaparison with those of the control, the epilepsy group showed that the NREM ( non rapid eye movement sleep) stage Ⅰ- Ⅱ was longer(68±6.61% and 56.33±7.01 % respectively), the NREM stage Ⅲ-Ⅳ was shorter (7. 03±5. 41% and 18.42±6. 94 % respectively) . There were a significance difference between the two groups (P＜0。 01) . 3. The arousal times (268 times) in epilepsy were higher than those (15 times) of the control (P＜0.01). 4. The results of correlated analysis showed that there was a significant positive correlation between the arousal times and the frequency of epileptifora discharges in epilepsy (r=0.639, P＜0. 01). 5. The sleep spindles in 12 patients (21%) decreased and asymmetrical, normal in the control. Conclusion: There were the sleep disorders in patients with epilepsy . The epileptic activity during interictal can obvious influences on sleep quality in patients with epilepsy.     

Pathogenesis of trigeminal neuralgia

<正>To the editor,I read with interest the article,"Differences in individual susceptibility affect the development of trigeminal neuralgia"by Duransoy et al.(2013).The authors have analyzed the possible pathogenesis of trigeminal neuralgia,with illustrative case examples.They have drawn very important conclusions,which may have implications in     

Differences in individual susceptibility affect the development of trigeminal neuralgia

Trigeminal neuralgia is a syndrome due to dysfunctional hyperactivity of the trigeminal nerve,and is characterized by a sudden,usually unilateral,recurrent lancinating pain arising from one or more divisions of the nerve.The most accepted pathogenetic mechanism for trigeminal neuralgia is compression of the nerve at its dorsal root entry zone or in its distal course.In this paper,we report four cases with trigeminal neuralgia due to an unknown mechanism after an intracranial intervention.The onset of trigeminal neuralgia after surgical interventions that are unrelated to the trigeminal nerve suggests that in patients with greater individual susceptibility,nerve contact with the vascular structure due to postoperative pressure and changes in cerebrospinal fluid flow may cause the onset of pain.     

An epidemiologic study of mitochondrial membrane transporter protein gene polymorphism and risk factors for neural tube defects in Shanxi, China

The present study involved a questionnaire survey of 156 mothers that gave birth to children with neural tube defects or had a history of pregnancy resulting in children with neural tube defects (case group) and 156 control mothers with concurrent healthy children (control group) as well as detection of mitochondrial membrane transporter protein gene [uncoupling protein 2 (UCP2)] polymorphism. The maternal UCP2 3’ untranslated region (UTR) D/D genotype and D allele frequency were significantly higher in the case group compared with the control group (odds ratio (OR) 3.233; 95% confidence interval (CI) 1.103-9.476; P = 0.040; OR: 3.484; 95% CI: for neural tube defects 2.109-5.753; P < 0.001). Univariate and multivariate logistic regression analysis of risk factors for neural tube defects showed that a maternal UCP2 3’ UTR D/D genotype was negatively interacted with the mothers’ consumption of frequent fresh fruit and vegetables (S = 0.007), positively interacted with the mothers’ frequency of germinated potato consumption (S = 2.15) and positively interacted with the mothers’ body mass index (S = 3.50). These findings suggest that maternal UCP2 3’ UTR gene polymorphism, pregnancy time, consumption of germinated potatoes and body mass index are associated with an increased risk for neural tube defects in children from mothers living in Shanxi province, China. Moreover, there is an apparent gene-environment interaction involved in the development of neural tube defects in offspring.     

Effects of polygonatum sibiricum polysaccharide on learning and memory in a scopolamine-induced mouse model of dementia★

BACKGROUND： Learning and memory processes are accompanied by complex neuropathological and biochemical changes. Free radicals play an important role in learning and memory damage. OBJECTIVE： To observe the effects of polygonatum sibiricum polysaccharide （PSP） in comparison with vitamin 12 on inhibiting free radical damage, as well as improving the degree of cerebral ischemia and learning and memory in a scopolamine-induced mouse model of dementia. DESIGN： Randomized controlled animal study. SETTINGS： Department of Pharmacology, Taishan Medical College; Shandong Jewim Pharmaceutical Co., Ltd. MATERIALS： A total of 105 healthy Kunming mice, comprising 90 males and 15 females that were clean grade, were provided by the Animal Center of Taishan Medical College. PSP （extracted and purified by Huangjing, Taishan） was provided by the Department of Traditional Chinese Medicine, Taishan Medical College （purity of 79.6% by using a phenol-concentrated sulphate acid method）, and hydrogen bromine acid scopolamine injection solution （SCO） by Shanghai Hefeng Pharmaceutical Co., Ltd. METHODS： This study was performed at the Pharmacological Laboratory of Taishan Medical College from March to June 2007. （1） A total of 75 healthy Kunming male mice of clean grade were randomly divided into a normal control group, positive control group, and low-dosage and high-dosage PSP groups, with 15 mice in each group. Mice in both the low-dosage and high-dosage PSP groups were intragastrically administered 0.5 g/kg and 2.0 g/kg PSP, respectively. Mice in the positive control group were intragastrically administered 0.5 g/kg vitamin 12. In addition, mice in both the normal control group and model group were intragastrically administered the same volume of saline, respectively, once a day for 7 consecutive days. One hour after the final administration on day 6, mice in the positive control group, model group, low-dosage and high-dosage PSP groups were subcutaneously injected with 3.0 mg/kg SCO, while mice in the no     

Expression of angiogenic factors in cerebral arteriovenous malformations

BACKGROUND： In the process of vascularization, vascular endothelial growth factor （VEGF）, angiopoietin-2 and Tie2 are involved in the migration, differentiation and proliferation of vascular endothelial cells, and stimulate the rapid angiogenesis; Tiel and angiopoietin-1 play important roles in facilitating the formation of vascular lumen and maintaining the integrity of vascular wall. Thus the distributions and expressions may be associated with the occurrence of cerebral arteriovenous malformation. OBJECTIVE： To observe the biological effects of angiogenic factors in the occurrence and development of cerebral arteriovenous malformation. DESIGN： An observational comparative experiment. SETTINGS： Department of Neurosurgery, General Hospital of Shenyang Military Area Command of Chinese PLA; Department of Neurosurgery, General Hospital of Tianjin Medical University. PARTICIPANTS： Fresh samples of complete cerebral arteriovenous malformations resected in 47 patients were collected from the Department of Neurosurgery, General Hospital of Tianjin Medical University from August 1999 to May 2001, including 22 males and 25 females, the mean age was 34.5 years. Informed consents were obtained from all the patients or their relatives. The initial symptom was hemorrhage in 28 cases. All the patients were classified according to the clinical imaging data and Spetzler-Martin grading standard, including 11 cases of grade Ⅰ, 17 cases of grade Ⅱ, 11 cases of grade Ⅲ, and 8 cases of grade Ⅳ - Ⅴ. Normal brain tissues resected by decompression due to trauma were taken from 8 patients as controls, including 5 males and 3 females, aging 12 - 65 years. METHODS： ① The expressions of VEGF, Tie receptors, angiopoietin-1, angiopoietin-2, proto-oncogene c-myc and proliferating cell nuclear antigen（PCNA） in the samples of cerebral arteriovenous malformation were detected with immunohistochemical method. Under light microscope, the positively stained rat-anti-human factor Ⅷ-related antigens （specific marker of vascular endothelial cells） were counted, then the immuno-positive cells of the other antibodies in the visual field of neighboring section which was in ＂mirror＂ relation were counted, and the percentage of the latter to the former was considered as the labeling index of positive cells. The immunostaining intensity was classified negative （ - ）： no positive cells; positive （＋）： number of positive cells 〈 20%; moderately positive （＋＋）： number of positive cells 20% - 50%; strongly positive （＋＋＋）： number of positive cells 〉 50%. ② The differences of the enumeration data were compared with chi-squam test, and the correlation were analyzed with the linear correlation analysis. MAIN OUTCOME MEASURES： Expressions and distributions of VEGF, Tie 1 and Tie2 receptors, angiopoietin-1, angiopoietin-2, PCNA and c-myc in the samples of cerebral arteriovenons malformation and normal brain tissue. RESULTS： ① Expressions of angiogenic factors in the control group and cerebral arteriovenons malformation groups of each grade： The positive rates of VEGF, Tie2, angiopoietin-2, c-myc and PCNA expressions in the control group were significantly different from those in the cerebral arteriovenous malformation groups of each grade （ x^2=21.09 - 34.23, P 〈 0.05）, whereas the positive rates of Tiel and angiopoietin-1 expressions were close （ x^2=3.43 - 3.869, P 〉 0.05）. ② Expressions of angiogenic factors in hemorrhage group and non-hemorrhage group： The expressions of VEGF, angiopoietin-2 and PCNA in the hemorrhage group were significantly lower than those in the non-hemorrhage group （ x^2= 16.22 - 26.56, P 〈 0.05）. There ware no obvious differences in the expressions of Tiel and angiopoietin-1 expressions between the hemorrhage group and non-hemorrhage group （ x^2=3.22 - 3.78, P 〉 0.05）.The VEGF was positively correlated with the expressions of c-myc and PCNA （r = 0.728, 0.916, P 〈 0.05）. CONCLUSION： ①The expressions of angiogenic factors and related receptors may be involved in the process of cerebral arteriovenous malformation, and had important correlation the its clinical grading. ② Angiogenic factors may induce the expression of endothelial cell c-myc in cerebral arteriovenous malformation, and then interfere the cell proliferation and apoptosis.     

Changes in hippocampal neurons and memory function during the developmental stage of newborn rats with hypoxic-ischemic encephalopathy

BACKGROUND: Under the normal circumstance, there exist some synapses with inactive functions in central nervous system (CNS), but these functions are activated following nerve injury. At the early stage of brain injury, the abnormal functions of brain are varied, and they have very strong plasticity and are corrected easily. OBJECTIVE: To observe the changes of neuronal morphology in hippocampal CA1 region and memory function in newborn rats with hypoxic-ischemic encephalopathy(HIE) from ischemia 6 hours to adult. DESIGN: Completely randomized grouping, controlled experiment. SETTING: Taian Health Center for Women and Children; Taishan Medical College. MATERIALS: Altogether 120 seven-day-old Wistar rats, of clean grade, were provided by the Experimental Animal Center, Shandong University of Traditional Chinese Medicine. Synaptophysin (SYN) polyclonal antibody was provided by Maixin Biological Company, Fuzhou. METHODS: This experiment was carried out in the Laboratory of Morphology, Taishan Medical College between October 2000 and December 2003. ① The newborn rats were randomly divided into 2 groups: model group and control group, 60 rats in each group. Five rats were chosen from each group at postoperative 6 hours, 24 hours, 72 hours, 7 days, 2 weeks and 3 weeks separately for immunohistochemical staining. Fifteen newborn rats were chosen from each group at postoperative 4 weeks and 2 months separately for testing memory ability (After test, 5 rats from each group were sacrificed and used for immunohistochemical staining)② The right common carotid artery of newborn rats of model group was ligated under the anesthetized status. After two hours of incubation, the rats were placed for 2 hours in a container filled with nitrogen oxygen atmosphere containing 0.08 volume fraction of oxygen, thus, HIE models were created; As for the newborn rats in the control group, only blood vessels were isolated, and they were not ligated and hypoxia-treated. ③ Thalamencephal tissue sections of newborn rats of two groups were performed DAB developing and haematoxylin slight staining. Cells with normal nucleous in 250 μm-long granular layer which started from hippocampal CA1 region were counted with image analysis system under high-fold optical microscope (×600), and the thickness of granular layer was measured. The absorbance (A) of positive reactant of SYN in immunohistochemically-stained CA1 region was measured. Learning and memory ability were measured with step through test 3 times successively. ④ t test and paired t test were used for comparing intergroup and intragroup difference of measurement data respectively, and Chi-square for comparing the difference of enumeration data. MAIN OUTCOME MEASURES: Comparison of cytological changes in hippocampal CA1 region and memory ability at different postoperative time points between two groups. RESULTS: Totally 120 newborn rats were involved in the result analysis. ① Cell morphological changes in hippocampal CA1 region: In the control group, with aging, perikaryon, nucleus and nucleolus in cortex of parietal lobe were significantly increased, Nissl body was compacted, the amount of neurons was declined, but the A of SYN positive reactant was relatively increased. In the model group, at postoperative each time point, neurons were seriously shrunk and dark-stained, nucleus was contracted, chromatin was condensed, nucleolus was unclear, even cells disappeared, especially the cells in 6 hours and 24 hours groups. The amount of neurons with normal morphology in hippocampal CA1 region and granular layer thickness in the model group at postoperative each time point were significantly less or smaller than those in the control group at postoperative 6 hours respectively (t =3.002-1.254, P < 0.01). The A value of SYN positive reactant at postoperative 2, 3 and 4 weeks was significantly higher than that at previous time point (t =2.011－2.716,P < 0.05－0.01). ② Test results of learning and memory ability: In the first test, there was no significant difference in the ratio of rats which kept memory ability between two groups (P > 0.05); In the third test, the ratio of rats which kept memory ability in the model group was significantly lower than that in the control group at postoperative 4 weeks and 2 months[53%(8/15)，100%(15/15)；60%(9/15)，93%(14/15)，χ 2=2.863，2.901，P < 0.01]. CONCLUSION: The destroyed hippocampal structure induces the decrease of learning and memory ability of developmental rats. Early interference can increase the quality of neurons and also promote functional development of the nervous system.     

Distribution of nitric oxide synthase positive neurons in the substantia nigra of rats with liver cirrhosis

BACKGROUND: Nitrogen monoxide plays an important role in the physiological activity and pathological process of striatum in substantia nigra, and the nitric oxide synthase in substantia nigra may have characteristic changes after liver cirrhosis. OBJECTIVE: To observe the distribution and forms of nitric oxide synthase (NOS) positive neurons and fibers in substantia nigra of rats with liver cirrhosis. DESIGN: A comparative observational experiment. SETTINGS: Beijing Friendship Hospital; Capital Medical University. MATERIALS: Twenty 4-month-old male Wistar rats (120–150 g) of clean grade, were maintained in a 12-hour light/dark cycle at a constant temperature with free access to standard diet and water. Cryostat microtome (LEICA, Germany); All the reagents were purchased from Sigma Company. METHODS: The experiment was carried out in the Department of Anatomy (key laboratory of Beijing city), Capital Medical University from July 2000 to March 2002. The rats were randomly divided into normal group (n =10) and liver fibrosis group (n =10). Rats in the liver fibrosis group were subcutaneously injected with 60% CCl4 oil at a dose of 5 mL/kg for the first time, and 3 mL/kg for the next 14 times, twice a week, totally 15 times. Liver fibrosis of grades 5–6 was taken as successful models. Whereas rats in the normal group were not given any treatment. Four months after CCl4 treatment, all the rats were anesthetized to remove brain, and frontal frozen serial sections were prepared. The expressions of nitric oxide synthase positive neurons in substantia nigra of rats were observed under inverted microscope. The number and gray scale of cell body of nitric oxide synthase positive neurons in substantia nigra were detected with NADPH-diaphorase staining. MAIN OUTCOME MEASURES: ① Number and gray scale of cell body of nitric oxide synthase positive neurons in substantia nigra; ② Expressions of nitric oxide synthase positive neurons in substantia nigra. RESULTS: All the 20 rats were involved in the analysis of results. ① The nitric oxide synthase positive neurons in substantia nigra were obviously fewer in the liver cirrhosis group than in the normal group (P < 0.01), and the gray scale of the positive cell body was higher in the liver cirrhosis group than in the normal group (P < 0.05). ② Abundant nitric oxide synthase positive neurons were observed in substantia nigra of normal rats, the cell body of nitric oxide synthase positive neurons was clear and transparent, with short own cloudy processes. In substantia nigra of rats with liver cirrhosis, the body of nitric oxide synthase positive neurons were observed shrink obviously, less fibrin than normal. CONCLUSION: Rats with liver cirrhosis may suffer from the physiological dysfunction of neurons due to lack of fibers. The nitric oxide synthase positive neurons in substantia nigra can shrink and reduce.     

三叉神经根区周围蛛网膜粘连与HSV-1感染关系的实验研究

目的 研究三叉神经痛患者三叉神经根区周围蛛网膜粘连与单纯疱疹病毒Ⅰ型感染的关系.方法 实验组40 例三叉神经痛患者三叉神经根区粘连的蛛网膜,对照组20 例外伤患者蛛网膜,每例蛛网膜分别做病理切片,PCR 检测HSV-1 特异性基因片段以及用HSV-1 单克隆抗体检测抗原的表达.结果 实验组病理切片光镜下粘连的蛛网膜主要以炎细胞浸润、水肿、钙化以及粘液样变性为主,检测到HSV-1 特异性基因片段阳性率为72.5% (29 /40),抗原阳性率为17.5% (7 /40),即以潜伏感染为主,少部分呈增值性感染.对照组病理切片有3 例细胞轻度水肿,余均为正常蛛网膜结构.有4 例HSV-1 特异性基因片段阳性,无抗原阳表达.卡方检验实验组和对照组蛛网膜HSV-1 的感染率有统计学差异(P＜0.05).结论 三叉神经根区蛛网膜的粘连与HSV-1 的感染密切相关;粘连的蛛网膜加剧了根区动脉对三叉神经根的压迫,是加重三叉神经痛的病因之一.     

三叉神经痛显微血管减压术中非动脉压迫因素的处理策略

目的探讨三叉神经痛显微血管减压术中非动脉性压迫因素的处理对策,以提高手术效果。方法回顾性分析150例三叉神经痛显微血管减压术术中资料。根据不同的原因,单独或联合采取压迫静脉电凝切断、蛛网膜松解以感觉根纵向梳理术等处理方法。结果岩静脉接触或压迫18例,所有病例均将岩静脉电凝、切断,12例同时进行三叉神经感觉根纵向梳理术。岩静脉接触或压迫合并蛛网膜粘连8例,岩静脉电凝、切断同时行三叉神经颅内段全长蛛网膜粘连松解术。单纯蛛网膜肥厚、粘连5例,全部行三叉神经颅内段全长蛛网膜粘连松解术,同时进行三叉神经感觉根纵向梳理术。既无静脉压迫,也无蛛网膜粘连3例,均行三叉神经感觉根纵向梳理术。术后随访6个月至2年,疼痛消失者32例,2例明显缓解;3例出现面部轻度麻木,半年后消失;1例不全面瘫1年后恢复;1例术侧听力减退,1年后无恢复。结论三叉神经痛显微血管减压术中非动脉性致痛因素处理更为复杂,术中针对不同的原因,单独或联合采用压迫静脉电凝切断、蛛网膜松解、感觉根纵向梳理术,可望取得理想的止痛效果。     

三叉神经根区粘连蛛网膜组织中IL-6的表达及意义

目的探讨原发性三叉神经痛(TN)患者三叉神经根区粘连的蛛网膜组织中白细胞介素-6(IL-6)表达对单纯疱疹病毒Ⅰ型(HSV-1)的影响,并进一步探讨HSV-1感染与TN的关系。方法首先采用PCR方法检测TN患者三叉神经根区粘连的蛛网膜、无粘连的蛛网膜组织中HSV-1特异性基因片段,再用免疫印迹法分别检测上述组织中抗原的表达,从而确定病毒感染状态,将其重新划分为HSV-1潜伏感染组、增殖感染组、未感染组,再用酶联免疫吸附测定法分别定量检测三组蛛网膜标本组织和患者血清中IL-6水平。结果 HSV-1增殖感染组的蛛网膜组织中IL-6水平[(324.64±14.28)pg/g]高于潜伏感染组[(232.75±19.17)pg/g],潜伏感染组也高于未感染组[(93.54±14.08)pg/g],且均有统计学差异(P<0.01);血清中IL-6水平三组之间无明显差异(P>0.05)。结论 IL-6是HSV-1增殖感染过程中的重要介质。HSV-1的增殖感染可能诱发或加重三叉神经根区蛛网膜的粘连,蛛网膜组织可能也是HSV-1的潜伏基地。HSV-1感染可能是继血管压迫之外造成三叉神经根区蛛网膜粘连继而引发TN的另一重要因素。     

三叉神经根受照长度对伽玛刀治疗三叉神经痛疗效的影响

目的探讨伽玛刀治疗原发性三叉神经痛三叉神经根受照长度对疗效的影响。方法随访我中心2007年1月至2012年12月期间采用伽玛刀治疗的原发性三叉神经痛患者160例,分短照射组(1~2mm)和长照射组(3~4mm)两组,照射剂量均为75Gy,对比分析三叉神经根受射线照射长度与疗效之间的关系。结果病人特征包括性别、年龄、病程、随访时间等因素两组间无统计学差异(P0.05)。两组之间有效率无统计学差异(P=1.00),但并发症发生率差异显著(P0.01)。结论三叉神经根受照长度与并发症发生率具有相关性(P0.01),随着神经根受照长度增加并发症的发生率增加。     

显微血管减压术后复发三叉神经痛的手术治疗

目的探讨显微血管减压术后复发三叉神经痛的手术治疗方法。方法1998年1月至2005年12月采用显微神经外科手术治疗37例显微血管减压术后复发三叉神经痛患者，30例患者行三叉神经感觉根部分切断术，单纯三叉神经显微血管减压术3例，显微血管减压术加行感觉根部分切断术4例。结果95％患者术中发现有CPA局部蛛网膜明显增厚粘连。全部患者获平均38．2个月的随访。随访期间总有效率97％。并发症：行三叉神经感觉根部分切断术者术后均有面部麻木，随访期间均见不同程度好转；术后发生听力障碍合并轻度面瘫1例，复视1例，随访期间好转；术后发生化脓性脑膜炎1例，出院时治愈；1例高龄患者术后发生小脑半球出血，量约5ml，经保守治疗后好转出院。结论CPA局部蛛网膜严重粘连是导致显微血管减压术后疼痛复发的最重要原因，二次手术时的术式选择应以三叉神经感觉根部分切断术为主。     

ANTIBODIES AGAINST HERPES SIMPLEX VIRUS TYPE 1 SUBUNIT ANTIGENS IN PATIENTS WITH TRIGEMINAL NEURALGIA AND CONTROLS

Serum IgG antibody levels against herpes simplex virus (HSV) type 1 subunit (capsid, envelope, and excreted) antigens detected with radioimmunoassay were compared in 25 patients with trigeminal neuralgia and their age- and sex-matched controls. No significant differences were found between the patients and controls, either in the distribution of the antibody titers or in the mean titers against any of the subunit antigens tested. In 6 patients HSV antibody titers were tested before and after trigeminal root section; no significant changes were observed.     

Trigeminal neuralgia caused by contralateral supratentorial meningioma

Most trigeminal neuralgia is attributable to vascular compression of the root entry zone of the trigeminal nerve at the pons. Only about 5-10% of trigeminal neuralgia cases are caused by direct compression by ipsilateral cerebellopontine angle tumors. Trigeminal neuralgia caused by contralateral posterior fossa tumors are extremely rare. Cases in which neuralgia is caused by a contralateral supratentorial tumor have been seldom reported. This report describes a case of large meningioma in the left occipital region. The patient's right facial pain subsided gradually after tumor excision. This neuralgia is likely due to a displaced adjacent vessel that developed following brainstem distortion by the tumor.     

An anatomical study of the neurovascular relationships at the trigeminal root entry zone

We aimed to study the neurovascular relationships at the trigeminal root entry zone in the normal population to help determine the pathogenesis of trigeminal neuralgia. We studied 50 fresh cadavers asymptomatic for trigeminal neuralgia or other facial pain during life and examined the 100 trigeminal root entry zones (REZ) using either a transtentorial (34 cadavers) or an infratentorial approach (16 cadavers). A vascular relationship was seen in 39 REZ (39%). There was an arterial relationship in 34 REZ (superior cerebellar artery in 23, anterior inferior cerebellar artery in 7, and pontine branches of the basilar artery in 4). A venous relationship was seen in 5 REZ. There was vascular contact only in 28 REZ, displacement of the nerve in 7 and grooving of the nerve in 4. We concluded that a neurovascular relationship at the trigeminal root entry zone is not uncommon in an asymptomatic population. The incidence of a vascular relationship in the Indian population seems similar to that in other major series. Electron microscopic studies of the nerve at the site of vascular contact in normal and symptomatic populations may help determine the exact pathogenesis of trigeminal neuralgia.     

Disseminated hemorrhagic leukoencephalomyelitis with localization herpes simplex brain stem infection

Summary A case of widespread hemorrhagic and perivenous demyelinative leukoencephalomyelitis complicating a localized herpes simplex virus (HSV) brain stem infection is reported in a 28-year-old man. The presence of the virus is documented immunohistochemically and ultrastructurally. The spinal trigeminal tract at the level of the medulla oblongata contained viral antigen in the neurons, glia and in the vascular walls, including a few endothelial cells. The foci of demyelination showed deposits of gamma globulins and slight inflammatory infiltrations; the virus was absent from these lesions. It is postulated that HSV entered the central nervous system through the trigeminal nerve. Focal expression of the viral antigen on the endothelium in a sensitized host was the likely precipitating factor in the hyperacute autoimmune reaction, resulting in the widespread hemorrhagic and demyelinating lesions in the central nervous system.     

Operative findings in cases of trigeminal neuralgia without vascular compression: proposal of a different mechanism.

Trigeminal neuralgia is known to be caused by vascular compression at the trigeminal root entry zone (REZ) and microvascular decompression provides good outcome in most of cases. However, in some cases, no vascular compression was observed at the REZ. Over the last 2(1/2) years, the first author operated on 53 cases of trigeminal neuralgia with microvascular decompression and encountered nine cases where no offending vessels were noted at or near the REZ. They were divided into two groups: five cases involving an initial operation and four cases involving a second operation. In the former, arachnoid thickening, angulation or torsion of the root axis were common findings. Dissection of thick arachnoid around the root along the whole length reversed the root to be straight and flaccid. Complete pain relief was noted in four of five cases. In one case of atypical pain, constant facial pain remained. In the latter four cases, where the first operations were done more than 4 years before, thick granulation was noted around REZ without new offending vessels in two cases. In the remaining two cases, where no offending vessels were noted in the first operation, thick adhesion of a distal portion of the root with dura on the pyramidal bone was noted. Meticulous dissection of t he whole length of the root was done and complete pain relief was obtained. Delayed but complete pain relief in these nine cases was noted. Based on operative findings, arachnoid thickening or granulomatous adhesion between the root and surrounding structures can cause an abnormal course of the trigeminal nerve root, which causes root angulation and/or torsion. They can also cause pulsatile movement of the trigeminal nerve root. This tethering effect can promote abnormal root stretching force, especially at REZ, which might promote hyperexitability of the nerve.This speculative mechanism suggests that it is important to make the root free along the entire length, especially at its distal portion in cases with no offending vessels.