神经-血管接触与三叉神经痛：一项基于微血管减压术及多模态磁共振成像的纵向研究

Neurovascular contact is considered a frequent cause of trigeminal neuralgia (TN) and microvascular decompression with transposition of a blood vessel plays a key role in the treatment of TN. Although center hypothesis about neurovascular contact has been widely accepted, but little is known about the correlation between neurovascular contact classification and symptoms, cognition, and emotion. In addition, as for the patients with TN in addition to the vascular compression, whether there is also a central mechanism which is involved in pain is unclear. On this basis, this project will collect multimodal brain magnetic resonance imaging data of large sample TN patients combined with imaging data analysis, combine the testing results of behavior scale, and explore the structural and functional characteristics changes of patients with TN, as well as the correlation with neurovascular contact. In addition, based on the central factors, whether the central mechanisms are the underlying cause of TN, or merely a consequence of the disease remains in discussion. Therefore, this project will track the TN patients with vessels decompression and detect the dynamic changes of brain structure and function, and further to explore the causal relationship between brain changes and the pain. This study is expected to reveal the relationship of ‘brain structure-function-behavior-clinical index’ in theory. In clinical treatment, this study will provide MVD preoperative guidance for the treatment and prevent the recurrence of TN.

神经-血管接触被认为是三叉神经痛（TN）最常见的诱因，而微血管减压术（MVD）作为治疗TN的重要手段能有效的解除神经血管压迫。尽管神经血管接触的中枢假说已被广泛接受，但是神经血管接触分级与症状、认知、情绪等的相关性研究较少，而且对于TN患者除血管压迫外，是否也存在疼痛中枢机制的参与尚不明确。据此，本项目拟采集TN大样本多模态磁共振影像结合数据分析，联合行为量表，探究TN患者大脑结构和功能特性的变化，及其与神经血管接触分级的相关性。此外，在TN患者存在中枢成分的前提下，究竟是中枢神经机制引发TN，还是TN继发大脑特性改变，未有定论。因此，本项目拟进一步追踪研究MVD术后TN患者脑结构和功能的动态变化，以探究大脑特性变化与疼痛间的因果关系。本研究可望在理论上揭示”脑结构-脑功能-行为量表-临床指标”的关系；在临床应用上，可以为MVD术后检测、控制提供影像学证据。

神经-血管接触被认为是三叉神经痛（TN）最常见的诱因，但对于TN患者除血管压迫外，是否存在疼痛中枢机制的参与尚不明确。本项目拟采集微血管减压术前后TN的多模态磁共振影像结合数据分析，探究TN患者大脑结构和功能特性的变化，以及大脑特性变化与疼痛间的因果关系。首先，利用CAT12和TBSS的方法分别探索TN患者灰质及白质的结构改变特征，研究发现，与控制组相比， TN组在左侧眶额皮层及额下皮层（延伸至中央前回）皮层厚度变薄，左侧额上回区域皮层回指数降低，双侧额上皮层至前扣带回沟深减小，而TN和控制组间白质纤维骨架FA没有显著差异。其次，利用动态局部一致性（dReHo）的研究方法探究TN患者脑功能特征的异常改变，研究发现，TN患者组双侧丘脑的dReHo值高于控制组；左侧颞中回，顶上小叶和中央前回的dReHo值低于控制组。进一步以丘脑作为种子点，探究TN患者全脑水平的功能连接发现，发现与控制组相比， TN患者右侧额上回存在连接增强。综合上述结果，本研究为探讨TN患者大脑神经生理改变的作用机制奠定了坚实的工作基础，同时，在临床应用上可以为TN的治疗和控制提供重要的影像学依据。项目资助发表相关论文6篇，培养硕士生2名。项目投入经费20万，支出12.9376万，剩余经费计划用于本项目研究后续支出。