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Noorani A, Hung PSP, Zhang JY, Sohng K, Laperriere N, Moayedi M, Hodaie M. Pain relief reverses hippocampal abnormalities in trigeminal neuralgia. J Pain 2021; 23:141-155. [PMID: 34380093 DOI: 10.1016/j.jpain.2021.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/24/2021] [Accepted: 07/12/2021] [Indexed: 11/17/2022]
Abstract
Chronic pain patients frequently report memory and concentration difficulties. Objective testing in this population points to poor performance on memory and cognitive tests, and increased comorbid anxiety and depression. Recent evidence has suggested convergence between chronic pain and memory deficits onto the hippocampus. The hippocampus consists of heterogenous subfields involved in memory consolidation, behavior regulation, and stress modulation. Despite significant studies outlining hippocampal changes in human and chronic pain animal models, the effect of pain relief on hippocampal abnormalities remains unknown. Trigeminal neuralgia (TN) is a chronic neuropathic pain disorder which is highly amenable to surgical interventions, providing a unique opportunity to investigate the effect of pain relief. This study investigates the effect of pain relief on hippocampal subfields in TN. Anatomical MR images of 61 TN patients were examined before and 6 months after surgery. Treatment responders (n=47) reported 95% pain relief, whereas non-responders (n=14) reported 40% change in pain on average. At baseline, patients had smaller hippocampal volumes, compared to controls. After surgery, responders' hippocampal volumes normalized, largely driven by CA2/3, CA4 and dentate gyrus, which are involved in memory consolidation and neurogenesis. We propose that hippocampal atrophy in TN is pain-driven and successful treatment normalizes such abnormalities.
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Affiliation(s)
- Alborz Noorani
- Division of Brain, Imaging, and Behaviour - Systems Neuroscience, Krembil Research Institute, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Surgery and Institute of Medical Science, University of Toronto, Ontario, Canada; Collaborative Program in Neuroscience, University of Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Peter Shih-Ping Hung
- Division of Brain, Imaging, and Behaviour - Systems Neuroscience, Krembil Research Institute, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Surgery and Institute of Medical Science, University of Toronto, Ontario, Canada; Collaborative Program in Neuroscience, University of Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Jia Y Zhang
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Kaylee Sohng
- Division of Brain, Imaging, and Behaviour - Systems Neuroscience, Krembil Research Institute, Toronto Western Hospital, University Health Network, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Normand Laperriere
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Massieh Moayedi
- Collaborative Program in Neuroscience, University of Toronto, Ontario, Canada; Centre for Multimodal Sensorimotor and Pain Research, University of Toronto, Ontario, Canada; University of Toronto Centre for the Study of Pain, Toronto, Ontario, Canada; Division of Clinical & Computational Neuroscience, Krembil Research Institute, Toronto Western Hospital, University Health Network, Ontario Canada
| | - Mojgan Hodaie
- Division of Brain, Imaging, and Behaviour - Systems Neuroscience, Krembil Research Institute, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Surgery and Institute of Medical Science, University of Toronto, Ontario, Canada; Collaborative Program in Neuroscience, University of Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Ontario, Canada; Division of Neurosurgery, Krembil Brain Institute, Toronto Western Hospital, University Health Network, Ontario, Canada.
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Ciurea AV, Saceleanu V, Mohan A, Moreanu MS, Toader C. Craniopharyngiomas in children - experience of consecutive 152 operated cases. Acta Endocrinol (Buchar) 2020; 16:103-109. [PMID: 32685048 DOI: 10.4183/aeb.2020.103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Context Craniopharyngiomas (CPH) are benign tumors, rarely encountered in children, representing 5-6% of all intracranial tumors. Objective This study aimed to analyze the surgical management and quality of life in a series of CPH pediatric cases. Design This was a multicenter study performed over a 25-year period (1994 - 2019) in Bucharest. Subjects and Methods 152 children (0-17 years old) were treated for CPH. Preoperative manifestations were intracranial hypertension, endocrine dysfunction, visual impairment, ataxia, intellectual performance decrease. Results Considering all surgical approaches used, we advocate for pterional approach to best fit in CPH. We achieved gross-total removal (GTR) in 83 cases (54.4%), near-total resection (NTR) in 13 cases (9%), partial resection (PTR) in 51 cases (33.3%). 5 cases were biopsies (3.2%). Gamma Knife Surgery was performed in 10 cases (6.5%), all recurrences. At 6 months GOS revealed: Good Recovery 70 cases (46.2%), Moderate Disability 62 cases (40.7%), Severe Disability 13 (8.5%), Vegetative State 2 cases (1.3%), Deceased 5 cases (3.2%). Complications were: diabetes insipidus (89.3%); hypopituitarism (66.4%); hypothalamic damage (17.7%); visual deterioration (18.4%). Conclusions Surgery remains the main option, but GTR complications prove the necessity for a multidisciplinary approach. Outcome predicting factors are: age, tumor size, hydrocephalus degree, hypothalamic dysfunction.
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Affiliation(s)
- A V Ciurea
- "Carol Davila" University School of Medicine - Department of Neurosurgery
| | - V Saceleanu
- "Lucian Blaga" University of Sibiu, Faculty of Medicine - Department of Neurosurgery.,Sibiu County Emergency Hospital - Department of Neurosurgery, Sibiu
| | - A Mohan
- University of Oradea, Faculty of Medicine and Pharmacy - Department of Surgical Disciplines.,Bihor County Emergency Hospital - Department of Neurosurgery, Oradea, Romania
| | - M S Moreanu
- "Carol Davila" University School of Medicine - Department of Neurosurgery
| | - C Toader
- "Carol Davila" University School of Medicine - Department of Neurosurgery.,National Institute of Neurology and Neurovascular Diseases - Department of Neurosurgery, Bucharest
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