Retrospective Investigation of Brainstem Volume and Craniovertebral Junction Morphometry in Migraine Patients

Abstract

Aim: Migraine, a complex, multifactorial neurovascular brain disorder, might cause several functional and morphometric changes in the brain. Despite many studies, a consensus has not emerged on its pathophysiology, and it is not fully elucidated so far. Recently, changing brain structures in migraine with aura has been attracting the attention of the scientific periphery. The brainstem is a critical region in the pathogenesis of migraine. Another transition point is the craniovertebral junction. Regional pathologies might trigger off the pathogenesis of neurodegenerative and neurological diseases by affecting hydrodynamics. Moreover, there is insufficient data on the relationship between migraine and the craniovertebral junction. The present study aimed to make the volumetric analysis of brainstem volume in migraine with and without aura, perform some angular and linear measurements of the craniovertebral junction, and evaluate the effects of these parameters in migraine patients. Material and Methods: The study retrospectively analyzed the brain Magnetic Resonance Images of 108 migraine patients (aged 18 to 65). Their brainstem volumes were measured using volBrain (online brain MRI volumetry system). Also, the angular and linear parameters of craniovertebral junctions were derived from the images. The obtained data were transferred to the SPSS 22 package program and analyzed. Results: The mean brainstem volume was 17.21±2.79 cm3 in the migraine with aura group, 17.33±2.48 cm3 in the migraine without aura, and 19.27±2.76 cm3 in the control group. There was no statistically significant difference between migraine with and without aura groups (p>0.05). There was a statistically significant difference between the control and both migraine groups (p<0.05). Furthermore, the clivus-canal angle was significantly different between the control and patient groups. Conclusion: The study found that the brainstem volume was lower in the migraine groups (with and without aura) than in the control group. Also, the different clivus-canal angles between the control and patient groups show that this issue should be more comprehensively studied.

Keywords

• Migraine
• brainstem volume
• craniovertebral junction

Kaynakça

1. 1. Ferrari MD, Goadsby PJ, Burstein R, et al. Migraine. Nat Rev Dis Primers. 2022;8(1):2-20.
2. 2. Boran H, Bolay H. Migren Patofizyolojisi. Archives of Neuropsychiatry. 2013;50(1):1-7.
3. 3. Petrusic I, Dakovic M, Zidverc-Trajkovic J. Volume alterations of brainstem subregions in migraine with aura. Neuroimage Clin. 2019;22:101714.
4. 4. Marciszewski KK, Meylakh N, Di Pietro F, et al. Changes in brainstem pain modulation circuitry function over the migraine cycle. J Neurosci. 2018;38(49):10479-88.
5. 5. Ashina M. Migraine. The New England Journal of Medicine. 2020;383:1866-76.
6. 6. Bashir A, Lipton RB, Ashina S, Ashina M. Migraine and structural changes in the brain: a systematic review and meta-analysis. Neurology. 2013;81(14):1260-8.
7. 7. Matharu MS, Good CD, May A, et al. No change in the structure of the brain in migraine: a voxel‐based morphometric study. Eur J Neurol. 2003;10(1):53-7.
8. 8. Ashina S, Bentivegna E, Martelletti P, Eikermann-Haerter K. Structural and functional brain changes in migraine. Pain Ther. 2021;10(1):211-23.

9. 9. Kim JH, Suh SI, Seol HY, et al. Regional grey matter changes in patients with migraine: a voxel-based morphometry study. Cephalalgia. 2008;28(6):598-604.
10. 10. Bilgiç B, Kocaman G, Arslan AB, et al. Volumetric differences suggest involvement of cerebellum and brainstem in chronic migraine. Cephalalgia. 2016;36(4):301-8.
11. 11. Naguib LE, Azim GSA, Abdellatif MA. A volumetric magnetic resonance imaging study in migraine. Egypt J Neurol Psych. 2021;57(1):1-11.
12. 12. Rocca MA, Ceccarelli A, Falini A, et al. Brain gray matter changes in migraine patients with T2-visible lesions: a 3-T MRI study. Stroke. 2006;37(7):1765-70.
13. 13. Topuz A, Şimşek H. Kraniovertebral bileşke anomalilerinin tanı yöntemleri ve tedavi algoritması. Türk Nöroşir Derg. 2013;23(2):150-57.
14. 14. Asal N, Şahan M. Is there a relationship between migraine disease and the skull base angles?. Ortadogu Medical Journal. 2018;10(4):465-70.
15. 15. Flanagan M. The role of the craniocervical junction in craniospinal hydrodynamics and neurodegenerative conditions. Neurol Res Int. 2015;2015.
16. 16. Aras Y, Ünal T. Kraniyovertebral kavşak anomalilerinin radyolojik değerlendirilmesi. Türk Nöroşir Derg. 2015;25(2):122-32.
17. 17. Kazancı A, Şimşek S. Kraniyovertebral bileşke: radyolojik değerlendirme ve ölçümler. Türk Nöroşir Derg. 2015;25(2):116-21.
18. 18. Tanrisever S, Orhan M, Bahşi İ, Yalçin E. Anatomical evaluation of the craniovertebral junction on cone-beam computed tomography images. Surg Radiol Anat. 2020;42(7):797-815.
19. 19. Güneş B, Vatansever A. Türk toplumunda foramen magnum ve kafa tabanındaki oluşumların ilişkileri. Kafkas Tıp Bilimleri Dergisi. 2018;8(3):207-13.
20. 20. Pallant J. SPSS kullanma kılavuzu SPSS ile adım adım veri analizi. Ankara, Türkiye: Anı Yayıncılık; 2017.
21. 21. Qin ZX, He XW, Zhang J, et al. Structural changes of cerebellum and brainstem in migraine without aura. J Headache Pain. 2019;20(1):1-9.
22. 22. Weiller C, May A, Limmroth V, et al. Brain stem activation in spontaneous human migraine attacks. Nat Med. 1995;1(7):658-60.
23. 23. Chong CD, Plasencia JD, Frakes DH, Schwedt TJ. Structural alterations of the brainstem in migraine. Neuroimage-Clin. 2017;13:223-7.
24. 24. Messina R, Rocca MA, Colombo B, et al. Gray matter volume modifications in migraine: A cross-sectional and longitudinal study. Neurology. 2018;91(3):e280-e92.
25. 25. Henderson F, Wilson W, Mark A, Koby M. Utility of the clivo-axial angle in assessing brainstem deformity: pilot study and literature review. Neurosurgical review. 2018;41(1):149-63.
26. 26. Yuksel U, Burulday V, Akkaya S, et al. Possible predictive clinical and radiological markers in decision making for surgical intervention in patients with Chiari Malformation type 1. Neurol Res. 2022:1-14.
27. 27. Chandra P, Goyal N, Chauhan A, et al. The severity of basilar invagination and atlantoaxial dislocation correlates with sagittal joint inclination, coronal joint inclination, and craniocervical tilt: a description of new indexes for the craniovertebral junction. Oper Neurosurg. 2014;10(4):621-30.
28. 28. Nascimento J, Neto E, Mello-Junior C, et al. Diagnostic accuracy of classical radiological measurements for basilar invagination of type B at MRI. Eur Spine J. 2019;28(2):345-52.