title: The trigeminal vasculature pathology in patients with neuralgia.
abstract: OBJECTIVE
  To examine the possible pathological changes of the trigeminal vasculature in patients with neuralgia.
  
  
  BACKGROUND
  Such a study has never been performed before. The alterations of the trigeminal vessels could have important pathophysiological implications in the trigeminal neuralgia pathogenesis.
  
  
  METHODS
  The biopsy specimens for the electronmicroscopic (EM) and immunohistochemical examination were taken during a partial rhizotomy in 6 patients with trigeminal neuralgia and in 2 persons with trigeminal neuropathy. In addition, the 32 normal trigeminal nerves were used as the control specimens.
  
  
  RESULTS
  The vascular pathological alterations were noticed in 3 out of 6 neuralgia patients. The EM study revealed signs of apoptosis or degeneration, respectively, of some endothelial and smooth muscle cells in the wall of the trigeminal arterioles. The immune reactions against CD31, CD34, and alpha-smooth muscle actin in these cells were weaker than in the control specimens, but stronger against factor VIII. In addition, the arteriolar basement membranes, which were thickened, showed an intense laminin, fibronectin, and collagen IV immunoreactivity. Similarly, some endothelial cells and pericytes of the intratrigeminal capillaries also showed signs of apoptosis or degeneration, respectively. Their basement membrane was very thick and showed an intense immune reaction against laminin, fibronectin, and collagen IV.
  
  
  CONCLUSIONS
  The observed pathological changes of the trigeminal vasculature could be the primary factor, while demyelination of the trigeminal nerve fibers could be the secondary process in some patients with neuralgia.
authors.affiliation: Institute of Anatomy, School of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Slobodan
authors.initials: S
authors.lastname: Marinković
authors.forename: Vera
authors.initials: V
authors.lastname: Todorović
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Gibo
authors.forename: Mirela
authors.initials: M
authors.lastname: Budec
authors.forename: Neda
authors.initials: N
authors.lastname: Drndarević
authors.forename: Dragoslava
authors.initials: D
authors.lastname: Pesić
authors.forename: Milos
authors.initials: M
authors.lastname: Joković
authors.forename: Mila
authors.initials: M
authors.lastname: Cetković
mesh_terms: D000328:Adult; D000368:Aged; D001160:Arterioles / Q000473:pathology; D002196:Capillaries / Q000473:pathology; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D019051:Rhizotomy; D014276:Trigeminal Nerve / Q000098:blood supply* / Q000473:pathology; D014277:Trigeminal Neuralgia / Q000473:pathology* / Q000601:surgery