BMC medical imaging · 2025
Glymphatic and neurofluidic dysfunction in classical trigeminal neuralgia: a multimodal MRI study of brain-CSF functional and structural dynamics.
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Chen Fenyang, Zhang Zhiliang, Miao Jianliang, Zhang Yvting, Wang Ding, Yan Juncheng, Pan Lei, Ye Haiqi, Ding Zhongxiang, Ge Xiuhong
Аннотация
OBJECTIVE: To investigate whether dysfunction of the glymphatic system and altered neurofluidic dynamics contribute to the pathophysiology of classical trigeminal neuralgia (CTN), and to explore the potential interplay between brain-CSF coupling and structural brain changes.
METHODS: A total of 131 patients with CTN and 106 age- and sex-matched healthy controls were recruited. All participants underwent multimodal MRI, including high-resolution structural imaging, resting-state functional MRI, and diffusion tensor imaging. Key indices included choroid plexus (CP) volume as a proxy for CSF production, global BOLD-CSF coupling as a measure of functional neurofluidic interaction, and the DTI-based ALPS index reflecting glymphatic clearance. Additional markers included peak width of skeletonized mean diffusivity (PSMD) and global gray/white matter and CSF volume. Partial correlation analyses were performed between imaging metrics and clinical assessments.
RESULTS: CTN patients showed significantly increased CP volume (P = 0.022) and gBOLD-CSF coupling (P < 0.001), along with reduced bilateral ALPS indices (P = 0.002, P = 0.004). PSMD and CSF volume were elevated (P < 0.001, P < 0.001), while gray and white matter volumes were reduced (P = 0.028, P = 0.009). gBOLD-CSF coupling correlated positively with depression, anxiety, and pain-related disability scores (P < 0.001), and negatively with MMSE (P = 0.022).
CONCLUSION: This study provides multimodal MRI evidence of glymphatic dysfunction and neurofluidic alterations in CTN, supporting a conceptual framework in which disrupted brain-CSF interaction may influence peripheral sensory modulation through a putative brain-CSF-ganglion pathway. These results may inform mechanistic hypotheses and guide future research on the neurofluidic underpinnings of neuropathic pain, potentially providing new insights into the pathogenesis of CTN.
METHODS: A total of 131 patients with CTN and 106 age- and sex-matched healthy controls were recruited. All participants underwent multimodal MRI, including high-resolution structural imaging, resting-state functional MRI, and diffusion tensor imaging. Key indices included choroid plexus (CP) volume as a proxy for CSF production, global BOLD-CSF coupling as a measure of functional neurofluidic interaction, and the DTI-based ALPS index reflecting glymphatic clearance. Additional markers included peak width of skeletonized mean diffusivity (PSMD) and global gray/white matter and CSF volume. Partial correlation analyses were performed between imaging metrics and clinical assessments.
RESULTS: CTN patients showed significantly increased CP volume (P = 0.022) and gBOLD-CSF coupling (P < 0.001), along with reduced bilateral ALPS indices (P = 0.002, P = 0.004). PSMD and CSF volume were elevated (P < 0.001, P < 0.001), while gray and white matter volumes were reduced (P = 0.028, P = 0.009). gBOLD-CSF coupling correlated positively with depression, anxiety, and pain-related disability scores (P < 0.001), and negatively with MMSE (P = 0.022).
CONCLUSION: This study provides multimodal MRI evidence of glymphatic dysfunction and neurofluidic alterations in CTN, supporting a conceptual framework in which disrupted brain-CSF interaction may influence peripheral sensory modulation through a putative brain-CSF-ganglion pathway. These results may inform mechanistic hypotheses and guide future research on the neurofluidic underpinnings of neuropathic pain, potentially providing new insights into the pathogenesis of CTN.