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Changes in the Muscles of Mastication Before and after Primary Stereotactic Radiosurgery in Patients with Idiopathic Trigeminal Neuralgia.

Journal of Histochemistry and Cytochemistry(2019)

Univ Virginia

Cited 3|Views18
Abstract
OBJECTIVE The motor root of the trigeminal nerve runs close to the sensory root and receives considerable radiation during Gamma Knife radiosurgery (GKRS) for trigeminal neuralgia (TN). The object of this study was to evaluate via MRI the changes in the muscles of mastication before and after upfront GKRS in patients with idiopathic TN. METHODS In this single-institution retrospective cohort study, all patients with idiopathic unilateral TN treated with primary GKRS at the University of Virginia in the period from 2007 to 2017 were included provided that they had preand post-GKRS MRI data. The thicknesses of the temporalis, pterygoid, and masseter muscles were measured on both pre and post-GKRS MRI in a blinded fashion. Changes in the muscles like fatty infiltration, MRI signal, or atrophy were noted. RESULTS Among the 68 patients eligible for inclusion in the study, 136 temporalis muscles, 136 medial pterygoid muscles, 136 lateral pterygoid muscles, and 136 masseter muscles were assessed. A subset of patients was found to have muscle atrophy even prior to GKRS. Pre-GKRS atrophy of the masseter, medial pterygoid, lateral pterygoid, and temporalis muscles was seen in 18 (26%), 16 (24%), 9 (13%), and 16 (24%) patients, respectively. Logistic regression analysis showed that distribution of pain in the V3 territory (p = 0.01, OR 5.43, 95% CI 1.46-20.12) and significant pain on chewing (p = 0.02, OR 5.32, 95% CI 1.25-22.48) were predictive of pre-GKRS atrophy. Reversal of atrophy of these muscles occurred after GKRS in a majority of the patients. The incidence of new-onset permanent post-GKRS muscle atrophy was 1.5%. The median follow-up was 39 months (range 6-108 months). CONCLUSIONS A subset of patients with TN with significant pain on chewing have pre-GKRS disuse atrophy of the muscles of mastication. A reversal of the atrophy occurs in a majority of the patients following GKRS. New-onset motor neuropathy post-GKRS was rare.
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Key words
stereotactic radiosurgery,Gamma Knife radiosurgery,trigeminal neuralgia,muscles of mastication,masseter,temporalis,motor root of trigeminal nerve,pain
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要点】:本研究通过MRI评估了在特发性三叉神经痛患者接受伽玛刀立体定向放射外科治疗前后咀嚼肌的变化,发现部分患者在治疗前就存在咀嚼肌萎缩,治疗后大多数患者的萎缩得到逆转,新发的术后运动神经病变罕见。创新点在于揭示了放射治疗对咀嚼肌影响的动态变化。

方法】:研究者在一个医疗机构回顾性分析了2007至2017年间接受原发性伽玛刀立体定向放射外科治疗的特发性单侧三叉神经痛患者,收集了他们治疗前后的MRI数据,并在不知情的情况下测量了颞肌、翼内肌和咬肌的厚度,记录了脂肪浸润、MRI信号变化或萎缩等肌肉变化。

实验】:研究共评估了68名患者,涉及136块颞肌、136块翼内肌、136块翼外肌和136块咬肌。结果显示,在伽玛刀治疗前,就有患者出现咀嚼肌萎缩。治疗前的萎缩在颞肌、翼内肌、翼外肌和咬肌中分别见于18名(26%)、16名(24%)、9名(13%)和16名(24%)患者。对疼痛分布和咀嚼时疼痛程度的逻辑回归分析显示,这两个因素预测了治疗前的萎缩。治疗后,大多数患者的萎缩得到了逆转,术后新发的永久性肌肉萎缩发生率为1.5%,中位随访时间为39个月(6-108个月)。