Neurovascular compression syndromes (NVCS), including trigeminal neuralgia (TN) and hemifacial spasm (HFS), are characterized by disabling symptoms caused by vascular compression of cranial nerves. Although microvascular decompression is an established treatment, mechanisms linking neurovascular compression to abnormal neural activity remain incompletely understood. In this review, we integrate evidence from microanatomical, electrophysiological, and computational studies to provide a mechanistic framework for NVCS. Chronic vascular compression induces focal demyelination, redistribution of voltage-gated ion channels, ectopic impulse generation, and ephaptic transmission, leading to abnormal neuronal excitation. We further summarize emerging evidence that persistent peripheral hyperactivity may contribute to electrophysiological alterations in central neural circuits. Particular attention is given to computational approaches, including cable theory and axonal interaction models, which offer quantitative insights into abnormal synchronization and cross-excitation among nerve fibers. Recent findings regarding ion channel dysfunction, including familial TN associated with gain-of-function calcium channel variants, are also discussed. Collectively, these findings support an integrated model linking neurovascular compression to clinical manifestations, and highlight the value of combining electrophysiology and computational neuroscience to improve mechanistic understanding and to guide future therapeutic strategies for NVCS.

Pathogenic variants of MYH11, which encode smooth muscle myosin heavy chain 11, have been linked to familial thoracic aortic aneurysms and dissections (FTAAD). However, molecular pathways affected by these mutations have not been well understood. To explore downstream consequences of Myh11 disruption, we analyzed transcriptomic and proteomic profiles of aortas from male Myh11 mice with homozygous deletion of lysine 1256 (K1256) and of wild-type controls. Of 6499 proteins quantified, 1763 were differentially expressed (adjusted p < 0.05), including 942 that were downregulated and 821 that were upregulated in mutant aortas. Enrichment analysis of downregulated genes and proteins revealed a consistent reduction in extracellular matrix-related pathways. Among downregulated proteins, we identified tenascin Xb, transforming growth factor β (Tgfb) 2, and Tgfb receptor 1/2, malfunctions of which are linked to connective tissue diseases, such as Ehlers–Danlos and Loeys–Dietz syndromes. Nevertheless, unlike these syndromic diseases, mice with Myh11 pathogenic variants and patients with FTAAD do not exhibit syndromic features, likely reflecting expression of Myh11 restricted to smooth muscle. These results suggest that loss of Myh11 disrupts maintenance of extracellular matrix by SMCs, the loss of which contributes to aortic fragility without affecting other tissues.

Familial thoracic aortic aneurysm and dissection (FTAAD), caused by the pathogenic Myh11 K1256del variant, is characterized by impaired aortic contractility; however, how reduced contractility predisposes the aorta to dissection remains incompletely understood. In this study, we performed a data-driven trans-omic upstream analysis using Genome Enhancer to identify key regulatory mechanisms in aortas from Myh11 K1256del mice under baseline conditions, without exposure to exogenous pathological stimuli. Transcriptome analysis revealed enrichment of genes related to smooth muscle contraction and regulation of myosin light chain phosphatase activity. Upstream computational analysis of regulatory regions identified nuclear factor of activated T cells 1 and lymphoid enhancer-binding factor 1 as major transcription factors, and further highlighted Rho-associated, coiled-coil-containing protein kinase 1 (ROCK1) as a predicted central regulator of the dysregulated transcriptional network. Druggability analysis suggested ROCK1 and the JunB proto-oncogene AP-1 transcription factor subunit as potential therapeutic targets. Furthermore, it predicted 51 candidate therapeutants, including atorvastatin, GSK-269962A, and atovaquone. These findings indicate that even in the absence of overt pathological stimulation, aortic tissue carrying the Myh11 K1256del variant exhibits a transcriptional program centered on ROCK signaling, which may prime the aorta for maladaptive responses to additional stress and may enhance susceptibility to dissection. This computational analysis requires experimental validation, but may provide a hypothesis-generating framework for development of preventive pharmacological interventions against FTAAD.