Assuntos
Neurilemoma , Humanos , Neurilemoma/cirurgia , Neurilemoma/diagnóstico por imagem , Neoplasias dos Nervos Cranianos/cirurgia , Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Procedimentos Neurocirúrgicos/métodos , Doenças do Nervo Trigêmeo/cirurgia , Doenças do Nervo Trigêmeo/diagnóstico por imagem , Cerebelo/irrigação sanguínea , Cerebelo/cirurgia , Cerebelo/diagnóstico por imagem , Feminino , Pessoa de Meia-IdadeRESUMO
The recent article "Clinical characteristics and outcomes after trigeminal schwannoma resection: a multi-institutional experience" by Nandoliya et al. offers critical insights into the management of trigeminal schwannomas (TS). This multi-institutional study, encompassing 30 patients over 18 years, highlights various surgical approaches, achieving gross-total resection in 53% of cases, and emphasizes the balance between resection and neurological preservation. The use of intraoperative neuromonitoring in 77% of cases is noted for minimizing morbidity. Despite a 13% complication rate, most were transient. Long-term follow-up data show a low recurrence rate, advocating for ongoing surveillance. The study underscores the importance of tailored surgical strategies, and the discussion of classification systems aids in contextual understanding. While the findings are robust, further research into adjuvant therapies and emerging technologies is warranted. This comprehensive overview advances our understanding of TS, promoting a patient-centered approach to surgical management.
Assuntos
Neoplasias dos Nervos Cranianos , Neurilemoma , Procedimentos Neurocirúrgicos , Humanos , Neurilemoma/cirurgia , Neoplasias dos Nervos Cranianos/cirurgia , Procedimentos Neurocirúrgicos/métodos , Resultado do Tratamento , Doenças do Nervo Trigêmeo/cirurgia , Complicações Pós-Operatórias/epidemiologiaRESUMO
Given their rarity, the clinical course of patients undergoing trigeminal schwannoma (TS) resection remains understudied. The objective of this study is to describe clinical characteristics and outcomes in patients undergoing surgical resection for TS in a multi-institutional cohort. This is a retrospective study of patients undergoing TS resection at two institutions between 2004 and 2022. Patient, radiographic, and clinical characteristics were reviewed and analyzed with standard statistical methods. Thirty patients were included. The median patient age was 43 (IQR: 35-52) years, and 14 (47%) patients were female. Median clinical and radiographic follow-ups were 43 (IQR: 20-81) and 47 (IQR: 27-97) months respectively. The most common presenting symptoms were trigeminal hypesthesia (57%) and headaches (30%), diplopia (30%), and ataxia/cerebellar signs (30%). The median maximum tumor diameter was 3.3 (IQR: 2.5-5.4) cm. Most tumors were Samii type C (50%) and mixed cystic-solid (63%). Surgical approaches included endoscopic endonasal (33%), supratentorial (30%), combined/staged (20%), infratentorial (10%), and anterior petrosal (7%) approaches. Gross-total resection was achieved in 16 (53%) patients. Radiographic tumor recurrence was noted in four patients at a median of 79 (range 5-152) months. Twenty-six (87%) patients reported improvements in at least one symptom by last follow-up. The most common perioperative complication was new cranial nerve deficit, with 17% of patients having a transient deficit and 10% having a permanent cranial nerve deficit. Surgical resection of TS showed good progression-free survival and symptom improvement, but was associated with cranial nerve deficits.
Assuntos
Neoplasias dos Nervos Cranianos , Neurilemoma , Procedimentos Neurocirúrgicos , Humanos , Neurilemoma/cirurgia , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Neoplasias dos Nervos Cranianos/cirurgia , Resultado do Tratamento , Estudos Retrospectivos , Procedimentos Neurocirúrgicos/métodos , Doenças do Nervo Trigêmeo/cirurgia , Complicações Pós-Operatórias/epidemiologiaRESUMO
BACKGROUND AND PURPOSE: Visualization of the extracranial trigeminal nerve is crucial to detect nerve pathologic alterations. This study aimed to evaluate visualization of the extracranial trigeminal nerve using 3D inversion recovery TSE with an improved motion-sensitized driven equilibrium (iMSDE) pulse. MATERIALS AND METHODS: In this prospective study, 35 subjects underwent imaging of the trigeminal nerve using conventional 3D inversion recovery TSE, 3D inversion recovery TSE with an iMSDE pulse, and contrast-enhanced 3D inversion recovery TSE. The visibility of 7 extracranial branches of the trigeminal nerve, venous/muscle suppression, and identification of the relationship between nerves and lesions were scored on a 5-point scale system. In addition, SNR, nerve-muscle contrast ratio, nerve-venous contrast ratio, nerve-muscle contrast-to-noise ratio, and nerve-venous contrast-to-noise ratio were calculated and compared. RESULTS: Images acquired with iMSDE 3D inversion recovery TSE had significantly higher nerve-muscle contrast ratio, nerve-venous contrast ratio, and nerve-to-venous contrast-to-noise ratio (all P < .001); improved venous/muscle suppression and clearer visualization of the trigeminal nerve branches except the ophthalmic nerve than with conventional 3D inversion recovery TSE (all P < .05). Compared with contrast-enhanced 3D inversion recovery TSE, images acquired with iMSDE 3D inversion recovery TSE had significantly higher SNR, nerve-muscle contrast ratio, and nerve-to-venous contrast-to-noise ratio (all P < .05), and demonstrated comparable diagnostic quality (scores ≥3) of the maxillary nerve, mandibular nerve, inferior alveolar nerve, lingual nerve, and masseteric nerve (P > .05). As for the identification of the relationship between nerves and lesions, iMSDE 3D inversion recovery TSE showed the highest scores among these 3 sequences (all P < .05). CONCLUSIONS: The iMSDE 3D inversion recovery TSE is a promising alternative to conventional 3D inversion recovery TSE and contrast-enhanced 3D inversion recovery TSE for visualization of the extracranial branches of trigeminal nerve in clinical practice.
Assuntos
Imageamento Tridimensional , Imageamento por Ressonância Magnética , Nervo Trigêmeo , Humanos , Masculino , Feminino , Nervo Trigêmeo/diagnóstico por imagem , Imageamento Tridimensional/métodos , Estudos Prospectivos , Adulto , Pessoa de Meia-Idade , Idoso , Imageamento por Ressonância Magnética/métodos , Adulto Jovem , Meios de Contraste , Aumento da Imagem/métodos , Doenças do Nervo Trigêmeo/diagnóstico por imagemRESUMO
Chronic neuropathic pain can result from nervous system injury and can persist in the absence of external stimuli. Although ongoing pain characterizes the disorder, in many individuals, the intensity of this ongoing pain fluctuates dramatically. Previously, it was identified that functional magnetic resonance imaging signal covariations between the midbrain periaqueductal gray (PAG) matter, rostral ventromedial medulla (RVM), and spinal trigeminal nucleus are associated with moment-to-moment fluctuations in pain intensity in individuals with painful trigeminal neuropathy (PTN). Since this brainstem circuit is modulated by higher brain input, we sought to determine which cortical sites might be influencing this brainstem network during spontaneous fluctuations in pain intensity. Over 12â min, we recorded the ongoing pain intensity in 24 PTN participants and classified them as fluctuating (n = 13) or stable (n = 11). Using a PAG seed, we identified connections between the PAG and emotional-affective sites such as the hippocampal and posterior cingulate cortices, the sensory-discriminative posterior insula, and cognitive-affective sites such as the dorsolateral prefrontal (dlPFC) and subgenual anterior cingulate cortices that were altered dependent on spontaneous high and low pain intensity. Additionally, sliding-window functional connectivity analysis revealed that the dlPFC-PAG connection anticorrelated with perceived pain intensity over the entire 12â min period. These findings reveal cortical systems underlying moment-to-moment changes in perceived pain in PTN, which likely cause dysregulation in the brainstem circuits previously identified, and consequently alter the appraisal of pain across time.
Assuntos
Imageamento por Ressonância Magnética , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Vias Neurais/fisiopatologia , Adulto , Tronco Encefálico/fisiopatologia , Tronco Encefálico/diagnóstico por imagem , Doenças do Nervo Trigêmeo/fisiopatologia , Idoso , Neuralgia do Trigêmeo/fisiopatologia , Neuralgia do Trigêmeo/diagnóstico por imagem , Medição da Dor , Córtex Cerebral/fisiopatologia , Córtex Cerebral/diagnóstico por imagemRESUMO
BACKGROUND: Trigeminal trophic syndrome is a rare cranial and facial condition caused by damage to the central or peripheral branches of the trigeminal nerve. This syndrome consists of a triad of anesthesia, paresthesia, and crescent-shaped facial ulcer involving the ala nasi and sometimes extending to the upper lip. Although previous screening for human immunodeficiency virus in some patients with trigeminal trophic syndrome was negative, we present a unique case of trigeminal trophic syndrome who tested positive for human immunodeficiency virus with eye complications. CASE PRESENTATION: We present a rare case of trigeminal trophic syndrome in a 44-year-old Black African woman who tested positive for human immunodeficiency virus. She presented with a 6-week history of progressive, persistent, and painless left sided facial and scalp ulcerations that started as small skin erosion. Diagnosis of trigeminal trophic syndrome was made on clinical grounds based on the triad of anesthesia, paresthesia, and unilateral crescent-shaped ulcer in the trigeminal dermatome and her past medical history. The ulcer healed completely after counseling and pharmacological therapy, but she later developed left periorbital cellulitis and left upper eyelid full-thickness defect. CONCLUSION: This is by far the first documented case of trigeminal trophic syndrome with a positive human immunodeficiency virus test. Testing for human immunodeficiency virus in patients with trigeminal trophic syndrome is necessary as this can help improve clinical management and treatment outcomes. Seeking the services of specialists remotely in resource constraint settings is beneficial for managing complications associated with trigeminal trophic syndrome.
Assuntos
Infecções por HIV , Humanos , Feminino , Adulto , Infecções por HIV/complicações , Doenças do Nervo Trigêmeo/diagnóstico , Celulite (Flegmão)/diagnóstico , Úlcera Cutânea/etiologia , Úlcera Cutânea/virologia , Parestesia/etiologia , Síndrome , Doenças Palpebrais/etiologia , Doenças Palpebrais/diagnósticoRESUMO
BACKGROUND: Trigeminal schwannoma is a rare type of tumor that arises from the Schwann cells of the trigeminal nerve. METHOD: We present a case of a patient with a giant V2 trigeminal schwannoma with painful swelling in the left maxilla. A complete resection using a combined open maxillectomy and endoscopic endonasal approach was performed. CONCLUSION: This case highlights the importance of a multidisciplinary approach to perform a combined open and endoscopic approach for safe resection while preserving adequate speech and swallowing.
Assuntos
Neoplasias dos Nervos Cranianos , Neurilemoma , Humanos , Neoplasias dos Nervos Cranianos/cirurgia , Neoplasias dos Nervos Cranianos/patologia , Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Endoscopia/métodos , Maxila/cirurgia , Maxila/diagnóstico por imagem , Cirurgia Endoscópica por Orifício Natural/métodos , Neurilemoma/cirurgia , Neurilemoma/diagnóstico por imagem , Neurilemoma/patologia , Resultado do Tratamento , Nervo Trigêmeo/cirurgia , Nervo Trigêmeo/patologia , Doenças do Nervo Trigêmeo/cirurgia , Doenças do Nervo Trigêmeo/patologiaAssuntos
Neoplasias dos Nervos Cranianos , Melanoma , Neurilemoma , Humanos , Melanoma/diagnóstico , Melanoma/patologia , Neurilemoma/diagnóstico , Neurilemoma/patologia , Neurilemoma/diagnóstico por imagem , Diagnóstico Diferencial , Neoplasias dos Nervos Cranianos/diagnóstico , Neoplasias dos Nervos Cranianos/patologia , Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Imageamento por Ressonância Magnética , Doenças do Nervo Trigêmeo/diagnóstico , Doenças do Nervo Trigêmeo/patologia , FemininoRESUMO
OBJECTIVES: To systematically report and document Trigeminal Trophic Syndrome (TTS), characterize its clinical presentation, diagnostic tests performed, outline management strategies, outcomes; and highlight the role of otolaryngologists in the tissue diagnosis of this rare syndrome. DATA SOURCES: PubMed/Medline, Scopus, and Cochrane databases. REVIEW METHODS: PubMed/Medline, Scopus, and Cochrane databases were systematically reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify all cases of TTS published with an English translation from inception to December 2020. RESULTS: A total of 142 articles describing 214 patients with TTS were included in the analysis. There was a female predominance (62.9 %) and a median age of 57 (range 1-93) years at presentation. A trigeminal neurological insult was identified in 200 (93.5 %) cases. The most common triggers for TTS were treatment for trigeminal neuralgia (35.7 %) and cerebrovascular accident (21.6 %). Self-inflicted trauma occurred in 137 (64 %) patients. Biopsy was done in 123 (57.5 %) patients. Patient education, barrier devices, and medications to address parasthesias were the most common treatment strategies. The majority of patients (72.5 %) received multimodal therapy. Surgery was performed in 35 (22.7 %) patients. Treatment outcomes were discussed in 120 (56.1 %) patients. CONCLUSIONS: TTS is a rare condition with poorly understood pathophysiology. It should be suspected in a patient with non-healing facial ulceration and altered sensation within the trigeminal nerve distribution. Biopsy of the ulcer is important to confirm the diagnosis and exclude malignancy. Treatment options include conservative and pharmacologic measures, and less frequently surgery.
Assuntos
Neuralgia do Trigêmeo , Humanos , Síndrome , Feminino , Idoso , Masculino , Pessoa de Meia-Idade , Adulto , Idoso de 80 Anos ou mais , Adolescente , Neuralgia do Trigêmeo/terapia , Neuralgia do Trigêmeo/diagnóstico , Doenças do Nervo Trigêmeo/diagnóstico , Doenças do Nervo Trigêmeo/etiologia , Adulto Jovem , Criança , Lactente , Pré-Escolar , Terapia CombinadaRESUMO
Data on the state of sense of smell in patients who had a new coronavirus infection caused by the SARS-CoV-2 virus are currently reduced because of the impairment of the olfactory nerve system. There are practically no results in studies of disorders in the trigeminal nerve system. OBJECTIVE: Qualitative assessment of olfactory disorders after COVID-19 according to the system of olfactory and trigeminal nerves with a targeted assessment of the functional component of olfactory disorders. MATERIAL AND METHODS: We examined 40 patients aged 19 to 66 who had a coronavirus infection. All patients underwent neurological, otorhinolaryngological examinations, olfactometry, filled out the hospital anxiety and depression scale. RESULTS: Anosmia was diagnosed in 5 (12.5%) patients, hyposmia in 21 (52.5%) patients, and normosmia in 14 (35%) patients. Formed: the 1st group - 14 patients (35%) with normogram according to olfactometry; the 2nd group - 26 patients (65%) with anosmia/hyposmia. In the 1st group, disorders of the anxiety-depressive spectrum were significantly more common. In the 2nd group, a low identification of odors was found, lying in the spectrum of fresh, sharp, unpleasant, irritating, compared with sweet and pleasant or neutral, which indicates a predominant lesion of the trigeminal system. CONCLUSION: In patients with complaints of impaired sense of smell after undergoing COVID-19, the possible functional nature of anosmia/hyposmia should be taken into account, which requires the referral of such patients to psychotherapeutic specialists, and the possible entry of olfactory disorders into the 'trigeminal' spectrum.
Assuntos
COVID-19 , Transtornos do Olfato , Nervo Trigêmeo , Humanos , COVID-19/complicações , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Transtornos do Olfato/etiologia , Transtornos do Olfato/fisiopatologia , Transtornos do Olfato/diagnóstico , Transtornos do Olfato/virologia , Nervo Trigêmeo/fisiopatologia , SARS-CoV-2 , Idoso , Olfato/fisiologia , Olfatometria/métodos , Anosmia/etiologia , Anosmia/fisiopatologia , Federação Russa/epidemiologia , Doenças do Nervo Trigêmeo/fisiopatologia , Doenças do Nervo Trigêmeo/etiologia , Doenças do Nervo Trigêmeo/diagnósticoRESUMO
BACKGROUND: Barometric pressure changes during flight or diving may cause facial barotrauma. Neuropathy of the fifth (CN5) or the seventh (CN7) cranial nerves is a rare manifestation of this condition. The aim of this study was to analyze risk factors for baroneuropathies of CN5 and CN7. METHODS: A search of PubMed and Cochrane Library databases was conducted to identify all published cases of CN5 and CN7 neuropathies. Only original case reports and series that documented events of neuropathies associated with the trigeminal nerve or facial nerve while flying, diving, or mountain climbing were included. Assessed variables included sex, medical history, age, setting (flight or diving), atmospheric pressure changes, number of episodes, symptoms, treatment, and recovery. RESULTS: We identified a total of 48 articles described >125 episodes in 67 patients. Mean age was 33.5 ± 12.1 years with a male predominance (76.1 %). Cases were equally distributed between flight and diving (50.7 %, 46.3 %, respectively). CN5 involvement was observed in 77.6 % of patients, with ear pain and facial numbness as the most common symptoms. The latter was correlated with positive otolaryngology medical history. CN7 was involved in 88.1 % of patients. Flying, as opposed to diving was correlated with spontaneous resolution of symptoms (86.7 % vs. 42.3 % of cases resolved spontaneously, respectively, p = 0.001). CONCLUSIONS: Flight is an equal risk factor to diving with respect to CN5 and CN7 barotrauma. Involvement of CN7 was observed in most cases, but possibly due to report-bias. Positive medical history is a risk factor for facial numbness.
Assuntos
Pressão Atmosférica , Barotrauma , Humanos , Barotrauma/etiologia , Fatores de Risco , Mergulho/efeitos adversos , Masculino , Doenças do Nervo Trigêmeo/etiologia , Feminino , Doenças do Nervo Facial/etiologia , AdultoRESUMO
BACKGROUND: Trigeminal trophic syndrome (TTS) is a rare condition caused by damage to the trigeminal nervous system, resulting in sensory disturbances and ulcers on the face. Treating TTS is complex and often requires medical or surgical intervention like flap reconstruction. However, there is limited research on surgical treatments for TTS ulcers. METHODS: We report the case of a 19-year-old man with TTS. We employed an innovative surgical technique involving dual cross-face nerve grafts. In the initial procedure, corneal neuralization was accomplished using supraorbital and cross-face infraorbital nerve graft. The subsequent operation utilized auricular composite tissue flap transplantation repair and cross-face mental nerve graft. RESULTS: This procedure led to rapid and sustained healing, as well as aesthetic improvement. CONCLUSION: Cross-face nerve grafts is a promising tool in the treatment of refractory ulcers caused by diseases such as TTS.
Assuntos
Doenças do Nervo Trigêmeo , Humanos , Masculino , Adulto Jovem , Doenças do Nervo Trigêmeo/cirurgia , Cicatrização/fisiologia , Retalhos Cirúrgicos/transplante , Úlcera Cutânea/cirurgia , Úlcera Cutânea/etiologia , Procedimentos de Cirurgia Plástica/métodos , Traumatismos do Nervo Trigêmeo/cirurgia , Síndrome , Nervo Trigêmeo/cirurgiaRESUMO
BACKGROUND: Trigeminal schwannomas (TSs) are intracranial tumors that can cause significant brainstem compression. TS resection can be challenging because of the risk of new neurologic and cranial nerve deficits, especially with large (≥ 3 cm) or giant (≥ 4 cm) TSs. As prior surgical series include TSs of all sizes, we herein present our clinical experience treating large and giant TSs via microsurgical resection. METHODS: This was a retrospective, single-surgeon case series of adult patients with large or giant TSs treated with microsurgery in 2012-2023. RESULTS: Seven patients underwent microsurgical resection for TSs (1 large, 6 giant; 4 males; mean age 39 ± 14 years). Tumors were classified as type M (middle fossa in the interdural space; 1 case, 14%), type ME (middle fossa with extracranial extension; 3 cases, 43%), type MP (middle and posterior fossae; 2 cases, 29%), or type MPE (middle/posterior fossae and extracranial space; 1 case, 14%). Six patients were treated with a frontotemporal approach (combined with transmastoid craniotomy in the same sitting in one patient and a delayed transmaxillary approach in another), and one patient was treated using an orbitofrontotemporal approach. Gross total resection was achieved in 5 cases (2 near-total resections). Five patients had preoperative facial numbness, and 6 had immediate postoperative facial numbness, including two with worsened or new symptoms. Two patients (28%) demonstrated new non-trigeminal cranial nerve deficits over mean follow-up of 22 months. Overall, 80% of patients with preoperative facial numbness and 83% with facial numbness at any point experienced improvement or resolution during their postoperative course. All patients with preoperative or new postoperative non-trigeminal tumor-related cranial nerve deficits (4/4) experienced improvement or resolution on follow-up. One patient experienced tumor recurrence that has been managed conservatively. CONCLUSIONS: Microsurgical resection of large or giant TSs can be performed with low morbidity and excellent long-term cranial nerve function.
Assuntos
Neoplasias dos Nervos Cranianos , Microcirurgia , Neurilemoma , Doenças do Nervo Trigêmeo , Humanos , Masculino , Feminino , Neurilemoma/cirurgia , Adulto , Pessoa de Meia-Idade , Neoplasias dos Nervos Cranianos/cirurgia , Neoplasias dos Nervos Cranianos/patologia , Estudos Retrospectivos , Microcirurgia/métodos , Doenças do Nervo Trigêmeo/cirurgia , Doenças do Nervo Trigêmeo/patologia , Procedimentos Neurocirúrgicos/métodos , Nervos Cranianos/cirurgia , Nervos Cranianos/patologia , Resultado do Tratamento , Adulto JovemRESUMO
Corneal neuropathy involves corneal nerve damage that disrupts ocular surface integrity, negatively impacting quality-of-life from pain and impaired vision. Any ocular or systemic condition that damages the trigeminal nerve can lead to corneal neuropathy. However, the condition currently does not have standardized diagnostic criteria or treatment protocols. The primary aim of this systematic review was to evaluate the efficacy and safety of interventions for treating corneal neuropathy. Randomized controlled trials (RCTs) that investigated corneal neuropathy treatments were eligible if the intervention(s) was compared to a placebo or active comparator. Comprehensive searches were conducted in Ovid MEDLINE, Ovid Embase and clinical trial registries from inception to July 2022. The Cochrane Risk-of-Bias 2 tool was used to assess study methodological quality. Certainty of the body of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Overall, 20 RCTs were included. Evaluated interventions comprised regenerative therapies (n = 6 studies), dietary supplements (n = 4), anti-glycemic agents (n = 3), combination therapy (n = 3), supportive therapies (n = 2) and systemic pain pharmacotherapies (n = 2). Nine RCTs were judged at high risk of bias for most outcomes. Definitions for corneal neuropathy in the populations varied substantially across studies, consistent with lack of consensus on diagnostic criteria. A diverse range of outcomes were quantified, likely reflecting absence of an agreed core outcome set. There was insufficient evidence to draw definitive conclusions on the efficacy or safety of any intervention. There was low or very low certainty evidence for several neuroregenerative agents and dietary supplements for improving corneal nerve fiber length in corneal neuropathy due to dry eye disease and diabetes. Low or very low certainty evidence was found for neuroregenerative therapies and dietary supplements not altering corneal immune cell density. This review identifies a need to standardize the clinical definition of corneal neuropathy and define a minimum set of core outcome measures. Together, this will provide a foundation for improved phenotyping of clinical populations in studies, and improve the capacity to synthesize data to inform evidence-based care. Protocol registration: PROSPERO ID: CRD42022348475.
Assuntos
Córnea , Humanos , Córnea/patologia , Córnea/inervação , Doenças da Córnea/terapia , Doenças da Córnea/diagnóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Doenças do Nervo Trigêmeo/terapia , Doenças do Nervo Trigêmeo/diagnóstico , Qualidade de VidaRESUMO
BACKGROUND AND OBJECTIVES: The association between orofacial neurotoxicity and chemotherapy treatment is still unclear. In this context, the purpose of this study is to relate the orofacial alterations that manifest during antineoplastic pharmacological treatment, highlighting the drugs commonly related to orofacial neuropathy and the adequate instrument to verify the alterations at clinical levels. METHODS: This prospective cohort study, addressed patients who would start therapy with taxanes, platinum, or related therapy. The collection of signs and symptoms was divided into 3 different times (baseline, second or third cycle of antineoplastic chemotherapy treatment, and sixth cycle). A total of 40 patients were submitted to the application of the Short McGill pain questionnaire and Neutoxicity Induced by Antineoplastics questionnaire (QNIA). To verify sensory alterations in the face, a clinical evaluation was performed with the help of Semmes-Weinstein monofilaments. RESULTS: Taxanes show greater orofacial neurotoxic potential, being associated with sensory alterations assessed by monofilaments (P = .003) and the presence of orofacial pain analyzed by the Short McGill pain questionnaire (P = .001). These medications related to neuropathy in the orofacial region measured through the QNIA, demonstrating a predominantly acute nature (P < .001). CONCLUSION: It is suggested that chemotherapy may induce neurotoxicity in the orofacial region.
Assuntos
Antineoplásicos , Humanos , Feminino , Masculino , Estudos Prospectivos , Pessoa de Meia-Idade , Inquéritos e Questionários , Antineoplásicos/efeitos adversos , Idoso , Medição da Dor , Síndromes Neurotóxicas/etiologia , Adulto , Doenças do Nervo Glossofaríngeo/induzido quimicamente , Dor Facial/induzido quimicamente , Doenças do Nervo Trigêmeo/induzido quimicamenteRESUMO
BACKGROUND: Although trigeminal nerve involvement is a characteristic of multiple sclerosis (MS), its prevalence across studies varies greatly due to MRI resolution and cohort selection bias. The mechanism behind the site specificity of trigeminal nerve injury is still unclear. We aim to determine the prevalence of trigeminal nerve involvement in patients with MS in a consecutive 7T brain MRI cohort. METHODS: This observational cohort originates from an ongoing China National Registry of Neuro-Inflammatory Diseases. Inclusion criteria were the following: age 18 years or older, diagnosis of MS according to the 2017 McDonald criteria and no clinical relapse within the preceding 3 months. Each participant underwent 7T MAGNETOM Terra scanner (Siemens, Erlangen, Germany), using a 32-channel phased array coil at Beijing Tiantan Hospital. T1-weighted magnetisation-prepared rapid acquisition gradient echoes, fluid-attenuated inversion recovery (FLAIR) and fluid and white matter suppression images were used to identify lesions. FLAIR* and T2* weighted images were used to identify central vein sign (CVS) within the trigeminal lesions. RESULTS: 120 patients underwent 7T MRI scans between December 2021 and May 2023. 19/120 (15.8%) patients had a total of 45 trigeminal lesions, of which 11/19 (57.9%) were bilateral. The linear lesions extended along the trigeminal nerve, from the root entry zone (REZ) (57.8%, 26/45) to the pontine-medullary nucleus (42.2%, 19/45). 26.9% (7/26) of the lesions in REZ showed a typical central venous sign. CONCLUSION: In this 7T MRI cohort, the prevalence of trigeminal nerve involvement was 15.8%. Characteristic CVS was detected in 26.9% of lesions in REZ. This suggests an inflammatory demyelination mechanism of trigeminal nerve involvement in MS.
Assuntos
Imageamento por Ressonância Magnética , Esclerose Múltipla , Nervo Trigêmeo , Humanos , Masculino , Feminino , Adulto , Esclerose Múltipla/diagnóstico por imagem , Esclerose Múltipla/patologia , Pessoa de Meia-Idade , Nervo Trigêmeo/diagnóstico por imagem , Nervo Trigêmeo/patologia , Estudos de Coortes , Doenças do Nervo Trigêmeo/diagnóstico por imagem , Adulto JovemRESUMO
Neurotrophic keratopathy (NK) is a challenging disease with the reduced innervation to the cornea. To establish a genetic and stable mouse model of NK, we utilized the TRPV1-DTR mice with intraperitoneal injection of diphtheria toxin (DT) to selectively eliminate TRPV1 neurons. After DT administration, the mice exhibited robust ablation of TRPV1 neurons in the trigeminal ganglion, accompanied with reduced corneal sensation and nerve density, as well as the decreased calcitonin-gene-related peptide (CGRP) and substance P levels. According to disease progression of TRPV1 neuronal ablation, tear secretion was reduced from day 3, which followed by corneal epithelial punctate lesions from day 7. From day 11 to day 16, the mice exhibited persistent corneal epithelial defects and stromal edema. By day 21, corneal ulceration and stromal melting were observed with the abundant inflammatory cell infiltration, corneal neovascularization, and enhanced cell apoptosis. Moreover, subconjunctival injection of CGRP delayed the NK progression with the characteristics of reduced severe corneal epithelial lesions and corneal inflammation. In addition, the impairments of conjunctival goblet cells, lacrimal gland, and meibomian gland were identified by the diminished expression of MUC5AC, AQP5, and PPARγ, respectively. Therefore, these results suggest that the TRPV1-DTR mice may serve as a reliable animal model for the research of NK pathogenesis.
Assuntos
Distrofias Hereditárias da Córnea , Ceratite , Doenças do Nervo Trigêmeo , Camundongos , Animais , Peptídeo Relacionado com Gene de Calcitonina/metabolismo , Córnea/metabolismo , Neurônios/metabolismo , Modelos Animais de Doenças , Canais de Cátion TRPV/genética , Canais de Cátion TRPV/metabolismoRESUMO
Peripheral trigeminal neuropathies are assessed by MR neurography for presurgical mapping. In this clinical report, we aimed to understand the utility of MR neurography following nerve-repair procedures. We hypothesized that postoperative MR neurography assists in determining nerve integrity, and worsening MR neurography findings will corroborate poor patient outcomes. Ten patients with peripheral trigeminal neuropathy were retrospectively identified after nerve-repair procedures, with postsurgical MR neurography performed from July 2015 to September 2023. Postsurgical MR neurography findings were graded as per postintervention category and subcategories of the Neuropathy Score Reporting and Data System (NS-RADS). Descriptive statistics of demographics, inciting injury, injury severity, NS-RADS scoring, and clinical outcomes were obtained. There were 6 women and 4 men (age range, 25-73 years). Most injuries resulted from third molar removals (8/10), with an average time from the inciting event to nerve-repair surgery of 6.1 (SD, 4.6) months. In Neuropathy Score Reporting and Data System-Injury (NS-RADS I), NS-RADS I-4 injuries (neuroma in continuity) were found in 8/10 patients, and NS-RADS I-5 injuries were found in the remaining patients, all confirmed at surgery. Surgeries performed included microdissection with neurolysis, neuroma excision, and nerve allograft with Axoguard protection. Three patients with expected postsurgical MR neurography findings experienced either partial improvement or complete symptom resolution, while among 7 patient with persistent or recurrent neuropathy on postsurgical MR neurography, one demonstrated partial improvement of sensation, pain, and taste and one experienced only pain improvement; the remaining 5 patients demonstrated no improvement. Postsurgical MR neurography consistently coincided with clinical outcomes related to pain, sensation, and lip biting and speech challenges. Lip biting and speech challenges were most amenable to recovery, even with evidence of persistent nerve pathology on postsurgical MR neurography.