摘要
目的采用近红外脑功能成像技术分析原发性三叉神经痛患者触发痛在微血管减压术前后的前额叶氧合血红蛋白变化,探讨前额叶皮层是否参与原发性三叉神经痛触发痛的调控。方法 6例原发性三叉神经痛患者前额叶接受45通道的近红外功能成像监测,前额叶氧合血红蛋白含量的变化反映触发痛任务相关的功能变化。采用多次重复事件相关设计作为任务,分析触发痛在微血管减压术前后的前额叶功能变化。结果 (1)术前疼痛侧刺激期相对静息期前额叶氧合血红蛋白的含量显著增高(P<0.05),双侧前额叶出现激活效应;术前正常侧刺激发现刺激期相对静息期前额叶氧合血红蛋白的含量显著降低(P<0.05),双侧前额叶出现抑制效应;(2)术后1周原疼痛侧和正常侧的静息期与刺激期之间均无统计学差异(P>0.05),均未见双侧前额叶激活或抑制效应。结论术前触发痛引起的双侧前额叶激活效应在微血管减压术后消失,推测前额叶可能参与原发性三叉神经痛中枢调控,其机制可能与中枢敏化现象有关。微血管减压术引起的外周神经和相邻组织的改变可能达到了去敏化效果。
Objective To study the effect of evoked pain with functional near-infrared spectroscopy(fNIRS)on the prefrontal lobe activation in patients with idiopathic trigeminal neuralgia,and investigate the prefrontal cortex involved in regulatory mechanism of the trigger pain.Methods A 45-channel fNIRS was employed to monitor the concentration changes of Oxy-Hb and Deoxy-Hb in the bilateral prefrontal cortex of totally 6 patients diagnosed according to the criteria about the idiopathic trigeminal neuralgia during the evoked pain tasks.The changes of Oxy-Hb could reflect prefrontal activation during the evoked pain.The characteristic activation of trigger pain in the prefrontal cortex was analynized around the microvascular decompression,with repeated event-related design as a task.Results (1)The trigger pain lead to the activation in bilateral prefrontal brain areas.The preoperative contralateral healthy side showed the bilateral prefrontal inhibitory effect;(2)The original ipsilateral and contralateral sides showed no bilateral prefrontal cortex significantly activation or inhibition effects,one week after the microvascular decompression.Conclusions The bilateral prefrontal activation effect caused by preoperative trigger pain disappeared after the operation,which suggested that the prefrontal cortex may indeed be involved in the regulatory mechanism of the idiopathic trigeminal neuralgia,which may be most relative to the phenomenon of central sensitization,what′s more,the changes of peripheral nerve and adjacent tissues,caused by the operation,may be reached to eliminate the sensitization.
出处
《中华临床医师杂志（电子版）》
CAS
2012年第19期5917-5921,共5页
Chinese Journal of Clinicians(Electronic Edition)
关键词
三叉神经痛
谱学
近红外线
额叶前皮质
触发痛
微血管减压术
Trigeminal neuralgia
Spectroscopy,near-infrared
Prefrontal cortex
Trigger pain
The microvascular decompression
