CT与DSA引导下行经皮穿刺三叉神经节射频热凝术临床应用对比

目的 分析CT与DSA引导下行经皮穿刺三叉神经节射频热凝术的临床价值.方法 选取2008-02-2013-01在我院进行治疗的三叉神经疼痛病人156例,按照随机数字法分为CT组（78例）和DSA组（78例）,观察2组患者的穿刺成功率.结果 CT组穿刺成功率98.7%,平均操作时间（55.4±1.2）min;DSA组的穿刺成功率89.7%,平均操作时间（24.6±13）min,2组平均操作时间和成功率比较差别有统计学意义（P〈0.05）.结论 在经皮穿刺三叉神经节射频热凝术中,采用DSA引导快速便捷,CT引导成功率更高,尤其对于卵圆孔及颅底解剖变异的病例具有明显优势.     

伽玛刀治疗原发性三叉神经痛长期随访疗效分析

目的分析伽玛刀治疗原发性三叉神经痛长期随访疗效、复发及并发症情况。方法回顾性分析142例应用伽玛刀治疗原发性三叉神经痛病人的临床资料,均行8年以上长期随访。采用巴罗神经学研究所（BNI）三叉神经痛评分标准对疗效进行评估,并总结长期疗效、复发及并发症情况。结果经长期随访,治疗达BNIⅠ-Ⅲ级134例,有效率94.4%,起效时间1-180 d;达BNIⅣ-Ⅴ级8例,治疗无效。复发24例（17.9%）,复发时间4-84个月。行2次治疗27例,治疗后有效率达85.2%。本组首次治疗后共发生并发症16例（11.3%）,大多数为一过性,随访期间逐渐消失。经统计学分析：有、无既往手术史的治疗后有效率差异显著（P〈0.05）,单、双靶点治疗和不同中心剂量的并发症发生率差异有统计学意义（P〈0.05）。结论伽玛刀治疗原发性三叉神经痛长期疗效良好,且具有术后复发率低、并发症轻微等优点,可作为治疗三叉神经痛首选方法之一。     

三叉神经根入脑干区MRI形态学研究

目的研究原发性三叉神经痛(TN)患者三叉神经根入脑干区(REZ)的形态结构及其临床应用价值。方法 36例TN患者和20例非TN患者作为健康对照纳入研究。所有受试对象采用3.0TMRI扫描,采用可变翻转角的三维快速自旋回波序列(3D-SPACE)分别扫描两侧REZ区的形态学结构。采取图像分析软件测量分析三叉神经脑池段长度、三叉神经脑桥角、桥小脑角池面积和三叉神经脑池段面积。结果患侧三叉神经脑池段长度的均值、三叉神经脑桥角的均值、桥小脑角池面积的均值以及三叉神经脑池段面积的均值均小于健侧。对照组的三叉神经脑池段长度、三叉神经脑桥角、桥小脑角池面积及三叉神经脑池段面积的均值均大于疾病组。结论三叉神经脑池段较短,三叉神经脑桥角锐利,易发生神经血管冲突,临床上易导致TN;三叉神经脑池段面积缩小提示三叉神经根的萎缩性改变。MRI形态学信息有利于疾病的诊断及手术决策的选择。     

猫三叉神经脊束间质核的细胞构筑学研究

用Nissl法和Golgi法，对猫三叉神经脊束间质核的位置、形态和细胞构筑进行了研究。确认，此核位于三叉神经脊束核尾侧亚核和极间亚核尾段的外侧、背侧的三叉神经告束内，吻尾长约8mm，主要包括二个部分。（1）在尾侧亚核至极间亚核尾段的外侧，细胞集聚呈不连续带状，与内侧的Ⅰ、Ⅱ层间有“蒂”相连；（2）在尾侧亚核吻段和极间亚核尾段的背侧，细胞集聚呈不规则片状，也与I、Ⅱ层相连续，但未形成明显的“蒂”。此核的细胞多为小（直径8～15μm）至中等大小（15～25μm），胞体为圆形，卵圆形或梭形，偶见大细胞（＞25μm），呈多角形或三角形．细胞的形态特征与员测亚核Ⅰ、Ⅱ层细胞相似，似为由Ⅰ、Ⅱ层延伸而来者．根据其位置、细胞构筑和纤维联系的全面观察，本文推测此核与口面部伤害性刺激的传递有密切关系。     

实验性牙移动中三叉神经节P2X3受体蛋白量及mRNA的表达变化

目的 研究正畸牙移动中P2X3受体蛋白量及mRNA在三叉神经节（TG）中的表达变化规律。方法 以雄性SD大鼠为实验对象,模拟临床矫治的牙移动过程,分别在实验4 h,1 d,2 d,3 d,5 d,7 d 和14 d时取出三叉神经节,应用Western blot分析检测P2X3受体蛋白的表达量,同时应用原位杂交方法对P2X3受体的表达部位及强度变化进行研究。结果 大鼠牙齿加力后,Western blot分析观察发现TG内P2X3受体蛋白量发生一定变化,并呈现一定的时间规律,在实验1 d后开始出现变化,3 d后达到高峰,14 d后下降至与对照组基本一致。同时观察到TG内P2X3 mRNA杂交信号阳性标记神经元的数量呈现一定的时间规律,与Western blot分析结果基本一致。结论 在大鼠牙移动过程中,TG中P2X3受体表达为一过性变化,呈现短时上调的规律,时间与正畸牙移动时的疼痛时间吻合,推测P2X3在正畸牙移动中可能与疼痛传导密切相关,但其作用机制还有待进一步探索。     

微血管减压术治疗三叉神经痛的疗效及其并发症的预防与处理

目的探讨微血管减压术治疗三叉神经痛的疗效及其并发症的预防与处理策略。方法采用微血管减压术治疗93例三叉神经痛患者,对其临床疗效及术后并发症等临床资料进行回顾性分析。结果 93例中89例术后疼痛症状消失,有效率为95.70%。术后并发症的发生情况：皮下积液4例,脑脊液漏1例,听力下降3例,耳鸣3例,面神经功能障碍4例,手术无效4例,死亡1例。结论微血管减压术治疗三叉神经痛是一种十分成熟的技术,规范手术的各种操作和积极应用监测技术能够尽量避免各种并发症的发生,显著提高手术的安全性。     

Rapid deterioration of intravascular large B-cell lymphoma with mass formation in the trigeminal nerve and multiple organ infiltration: An autopsy case report

Intravascular large B-cell lymphoma (IVLBCL) is a rare lymphoma characterized by the selective growth of lymphoma cells within the lumen of vessels. We describe the case of a 69-year-old male who presented with marked pain in the left facial region. Gadolinium-enhanced magnetic resonance imaging revealed a swollen left trigeminal nerve (TN) and positron emission tomography/computed tomography demonstrated fluorodeoxyglucose-only uptake at the same site. The patient had high serum lactate dehydrogenase and soluble interleukin-2 receptor levels. As random skin biopsy and bone marrow biopsy detected no abnormal pathogenesis, open biopsy of the TN was performed, revealing diffuse large B-cell lymphoma (DLBCL). However, ground glass opacities rapidly developed in both lung fields with severe respiratory failure. The patient died of progressive disease before the initiation of chemotherapy. Postmortem examination revealed widespread lymphoma cells in the lumen of vessels in multiple organs, including the lungs, excluding the bone marrow and skin. Lymphoma cells formed a mass in the TN and left lumbar plexus. A diagnosis of IVLBCL was made based on the postmortem pathological analysis. DLBCL of abnormal sites, such as the peripheral nervous system, should be considered in cases of IVLBCL as a differential diagnosis.     

Alterations in pain processing circuitries in episodic migraine

BackgroundThe precise underlying mechanisms of migraine remain unknown. Although we have previously shown acute orofacial pain evoked changes within the brainstem of individuals with migraine, we do not know if these brainstem alterations are driven by changes in higher cortical regions. The aim of this investigation is to extend our previous investigation to determine if higher brain centers display altered activation patterns and connectivity in migraineurs during acute orofacial noxious stimuli.MethodsFunctional magnetic resonance imaging was performed in 29 healthy controls and 25 migraineurs during the interictal and immediately (within 24-h) prior to migraine phases. We assessed activation of higher cortical areas during noxious orofacial heat stimulation using a thermode device and assessed whole scan and pain-related changes in connectivity.ResultsDespite similar overall pain intensity ratings between all three groups, migraineurs in the group immediately prior to migraine displayed greater activation of the ipsilateral nucleus accumbens, the contralateral ventrolateral prefrontal cortex and two clusters in the dorsolateral prefrontal cortex (dlPFC). Reduced whole scan dlPFC [Z + 44] connectivity with cortical/subcortical and brainstem regions involved in pain modulation such as the putamen and primary motor cortex was demonstrated in migraineurs. Pain-related changes in connectivity of the dlPFC and the hypothalamus immediately prior to migraine was also found to be reduced with brainstem pain modulatory areas such as the rostral ventromedial medulla and dorsolateral pons.ConclusionsThese data reveal that the modulation of brainstem pain modulatory areas by higher cortical regions may be aberrant during pain and these alterations in this descending pain modulatory pathway manifests exclusively prior to the development of a migraine attack.     

单侧咀嚼大鼠三叉神经节内PPTAmRNA及其相应蛋白的表达研究

目的:观察磨除单侧后牙造成单侧咀嚼的大鼠三叉神经节内P物质(substance P,SP)及编码 SP 的前速激肽原 A(PPTA)mRNA 的表达情况,进一步探讨颞颌关节病的发病机制.方法:Wistar 雄性大鼠48只,随机分为6组,包括3个实验组及相应对照组,每组8只.实验组动物磨除右侧上、下颌磨牙,人为造成单侧咀嚼.双侧三叉神经节切片行 SP 免疫组化(SABC法)和原位杂交反应.光镜观察拍片,并用 Image Pro Plus 5.1 图像分析软件进行测定.结果与对照组比较,用SPSS10.0软件进行统计分析.结果:每一实验组咀嚼侧和非咀嚼侧三叉神经节内 SP 免疫阳性神经元百分比与各自对照组比较显著降低(p<0.01,p<0.05),非咀嚼侧明显低于咀嚼侧(P<0.01,p<0.05).原位杂交结果显示,每一实验组咀嚼侧与非咀嚼侧三叉神经节中 PPTAmRNA 阳性神经元的数量较各自对照组明显增高(p<0.01),非咀嚼侧明显高于咀嚼侧(p<0.01,p<0.05).结论:三叉神经节内 SP 和 PPTAmRNA 参与了单侧咀嚼引起的颞颌关节病的病理过程,且两侧三叉神经节内SP释放量、PPTAmRNA 合成量不同.     

Inferior Alveolar Neurosensory Deficiency Associated With Placement of Dental Implants

Background: This study reports and analyzes a large series of patients with neurosensory deficiency related to the placement of dental implants (DIs) and resulting in liability claims (LCs). Methods: From 1998 to 2009, there were 92 LCs related to persistent altered sensation post DI placements in Israel. Patients’ demographics, year and source of LCs, interval between the procedure that resulted in a neurosensory deficiency and the LC, qualifications of the surgeon, preoperative imaging modality, DI length, available alveolar bone for DI placement, placement site, timing of DI placement (immediately after tooth extraction or after socket healing), and treatment after the diagnosis of neurosensory deficiency were recorded and analyzed. Results: There were 21 cases during the first 5 years of the study (mean 4.2/year) and 63 cases (mean 12.6/year) over the following 5 years. Thirty LCs were issued during the second postoperative year and 15 LCs after >5 years. Most LCs (76%) involved procedures that were planned and performed according to radiographs and 24% after computed tomography. Sixty‐five percent of the LCs were performed by general dental practitioners and 35% by specialists. More than one DI was performed during the surgical procedure that resulted in a neurosensory deficiency in 73 LCs (79.3%), and the DI was >10 mm in 55 (59.8%) cases. Conclusions: LCs for DIs that result in a neurosensory deficiency pose a legal risk to the practitioner long after the injury has occurred.