The trigeminal system: The meningovascular complex- A review

Area of Science:

• Neuroscience
• Vascular Biology
• Pain Research

Background:

• Supratentorial pain perception is primarily mediated by the trigeminal nerve, particularly its ophthalmic division, innervating the dura mater and cerebral blood vessels.
• Contrary to prior beliefs, mechanical stimulation of the pia mater and small cerebral vessels can elicit pain, highlighting the trigeminovascular system's role.

Purpose of the Study:

• To present comprehensive information on the dural and brain afferents of the trigeminovascular system.
• To enhance understanding of trigeminal cranial sensory perception.
• To stimulate new research into headache and other brain diseases.

Main Methods:

• This is a translational review, synthesizing existing knowledge on the trigeminovascular system.
• Information is gathered from studies on awake patients during surgery and anatomical/physiological investigations.

Main Results:

• The trigeminovascular system is strategically positioned at the neurovascular interface to detect sensory inputs and modulate blood flow.
• This system is implicated in pathologies like migraine and subarachnoid hemorrhage.
• Current understanding of its precise roles in headache, blood flow, blood-brain barrier permeability, and trigeminocardiac reflex remains incomplete.

Conclusions:

• The trigeminal nerve and trigeminovascular system are central to cranial sensory perception and vascular regulation.
• Incomplete knowledge necessitates increased investigation into the trigeminal system's anatomy and physiology.
• A deeper understanding is vital for advancing treatments for headache and other neurological conditions.