PREPONTİN MESAFENİN MİGREN HASTALIĞI İLE İLİŞKİSİ

Öz

Amaç Son yıllarda migren hastalığı, özellikle beynin posterior dolaşım bölgesindeki enfarktüs benzeri lezyonların geliştiği serebrovasküler yapıdaki değişiklikler ile ilişkilendirilmektedir. Posterior serebral dolaşımını sağlayan vertebrobaziller sistemin (VBS) geometrik yapısındaki farklılıkların, posterior kranial fossa (PKF) kalabalıklığı ile ilişkili olabileceğini düşünmekteyiz. Bu amaçla retrospektif olarak yapmış olduğumuz bu çalışmada, PKF’ye ait morfometrik özelliklerin migren ile ilişkisini araştırdık. Gereç ve Yöntem Çalışmamıza, 18-55 yaş aralığında 60 migren tanılı hasta ve 50 migren dışı tanı alan hasta dahil edilmiştir. Hastalara ait T1 ağırlıklı sagittal Manyetik Rezonans (MR) görüntüleri kullanılarak PKF kalabalıklığı göstergesi olan morfometrik parametreler ölçülmüştür. Bulgular Migren hastalarında prepontin ön-arka mesafesi kontrol grubuna göre daha kısa bulunmuştur (p=0,006). PFK kalabalıklığı göstergesi diğer parametrelerde gruplar arasında anlamlı bir farklılık bulunmamıştır. Sonuç Migren hastalarında, PKF kalabalıklığının göstergelerinden biri olan prepontin mesafenin kısa olması, bu aralıktaki a. basilaris veya n. trigeminus’un kompresyonuna sebep olarak migren hastalığının gelişmesinde bir risk faktörü olabilir.

Anahtar Kelimeler

• migren
• n. trigeminus
• vertebrobaziler sistem
• manyetik rezonans görüntüleme

THE RELATIONSHIP OF PREPONTINE DISTANCE WITH MIGRAINE DISEASE

Öz

Objective In recent years, migraine disease has been associated with changes in the cerebrovascular structure, especially in the development of infarctlike lesions in the posterior circulatory region. We think that the differences in the geometric structure of the vertebrobasilar system providing posterior circulation may be related to posterior cranial fossa (PCF) crowding. For this purpose, in this retrospective study, we investigated the relationship between the morphometric properties of PCF and migraine disease. Material and Method 60 patients diagnosed with migraine between the ages of 18-55 and 50 patients diagnosed with non-migraine patients were included in our study. Morphometric parameters, which are indicators auof PCF, were measured on T1-weighted sagittal Magnetic Resonance (MR) images of patients. Results Anterior-posterior diameter of the prepontine distance was statistically significantly lower in migraine patients compared to the control group (p=0.006). There was no significant difference between the groups in PCF crowding. Conclusion In migraine patients, the short prepontine distance, which is one of the indicators of PCF crowding, may be a risk factor in the development of migraine disease by causing compression of the basilar artery or trigeminal nerve located in this space.

Anahtar Kelimeler

• migraine
• trigeminal nerve
• vertebrobasilar system
• magnetic resonance imaging

Kaynakça

1. 1. Ferrari MD, Klever RR, Terwindt GM, Ayata C, van den Maagdenberg AMJM. Migraine pathophysiology: lessons from mouse models and human genetics. The Lancet Neurology. 2015;14(1);65–80.
2. 2. Silberstein SD. Migraine. Lancet (London, England). 2004;363(9406);381–391.
3. 3. Pietrobon D. Calcium channels and migraine. Biochimica et Biophysica Acta (BBA)-Biomembranes. 2013;1828(7);1655- 1665.
4. 4. Kruit MC, Launer LJ, Ferrari MD, van Buchem MA. Infarcts in the posterior circulation territory in migraine. The population- based MRI CAMERA study. Brain. 2005;128(9);2068–2077.
5. 5. Flanagan MF. The role of the craniocervical junction in craniospinal hydrodynamics and neurodegenerative conditions. Neurology Research International. 2015;794829.
6. 6. Asal N, Şahan MH. Is there a relationship between migraine disease and the skull base angles? Ortadoğu Tıp Dergisi. 2018;10(4);456–470.
7. 7. Milhorat TH, Chou MW, Trinidad EM, Kula RW, Mandell M, Wolpert C, et al. Chiari I malformation redefined: clinical and radiographic findings for 364 symptomatic patients. Neurosurgery. 1999;44(5);1005–1017.
8. 8. Nishikawa M, Sakamoto H, Hakuba A, Nakanishi N, Inoue Y. Pathogenesis of Chiari malformation: a morphometric study of the posterior cranial fossa. Journal of Neurosurgery. 1997;86(1);40–47.

9. 9. Kaplan Y, Oksuz E. Chronic migraine associated with the Chiari type 1 malformation. Clinical Neurology and Neurosurgery. 2008;110(8);818–822.
10. 10. Lin KH, Chen YT, Fuh JL, Wang SJ. Increased risk of trigeminal neuralgia in patients with migraine: a nationwide population-based study. Cephalalgia. 2016;36(13);1218–1227.
11. 11. Chen YY, Lirng JF, Fuh JL, Chang FC, Cheng HC, Wang SJ. Primary cough headache is associated with posterior fossa crowdedness: a morphometric MRI study. Cephalalgia: an International Journal of Headache. 2004;24(9);694–699.
12. 12. Cheng J, Meng J, Liu W, Zhang H, Hui X, Lei D. Primary trigeminal neuralgia is associated with posterior fossa crowdedness: a prospective case-control study. Journal of Clinical Neuroscience. 2018;47; 89–92.
13. 13. Lirng JF, Fuh JL, Chen YY, Wang SJ. Posterior cranial fossa crowdedness is related to age and sex: an magnetic resonance volumetric study. Acta Radiologica. 2005;46(7);737–742.
14. 14. Delaruelle Z, Ivanova TA, Khan S, Negro A, Ornello R, Raffaelli B, et al. Male and female sex hormones in primary headaches. The Journal of Headache and Pain. 2018;19(1);117.
15. 15. Ertas M, Baykan B, Orhan EK, Zarifoglu M, Karli N, Saip S, et al. One-year prevalence and the impact of migraine and tension- type headache in Turkey: a nationwide home-based study in adults. The Journal of Headache and Pain. 2012;13(2);147.
16. 16. Ha SM, Kim SH, Yoo EH, Han I, Shin DA, Cho KG, et al. Patients with idiopathic trigeminal neuralgia have a sharper-than-normal trigeminal-pontine angle and trigeminal nerve atrophy. Acta Neurochirurgica. 2012;154(9);1627–1633.
17. 17. Zhang C, Detre JA, Kasner SE, Cucchiara B. Basilar artery lateral displacement may be associated with migraine with aura. Frontiers in Neurology. 2018;9;80.
18. 18. Olesen J, Burstein R, Ashina M, Tfelt-Hansen P. Origin of pain in migraine: evidence for peripheral sensitisation. The Lancet Neurology. 2009;8(7);679–690.
19. 19. Bolay H, Reuter U, Dunn AK, Huang Z, Boas DA, Moskowitz MA. Intrinsic brain activity triggers trigeminal meningeal afferents in a migraine model. Nature Medicine. 2002;8(2);136– 142.
20. 20. Moskowitz MA, Nozaki K, Kraig RP. Neocortical spreading depression provokes the expression of c-fos protein-like immunoreactivity within trigeminal nucleus caudalis via trigeminovascular mechanisms. Journal of Neuroscience. 1993;13(3);1167–1177.
21. 21. Caplan LR. Migraine and vertebrobasilar ischemia. Neurology. 1991;41(1); 5.
22. 22. Mungoven TJ, Meylakh N, Marciszewski KK, Macefield VG, Macey PM, Henderson LA. Microstructural changes in the trigeminal nerve of patients with episodic migraine assessed using magnetic resonance imaging. J Headache Pain. 2020;21;1-11.
23. 23. Eppelheimer MS, Houston JR, Bapuraj JR, Labuda R, Loth DM, Braun, AM, et al. A retrospective 2D morphometric analysis of adult female chiari type I patients with commonly reported and related conditions. Frontiers in Neuroanatomy. 2018;12; 2.
24. 24. Guyuron B, Yohannes E, Miller R, Chim H, Reed D, Chance MR. Electron microscopic and proteomic comparison of terminal branches of the trigeminal nerve in patients with and without migraine headaches. Plastic and Reconstructive Surgery. 2014;134(5);796e.