Arteriovenous Malformation Surrounding the Trigeminal Nerve-Case Report-

Krischek, Boris; Yamaguchi, Sachiko; Sure, Ulrich; Benes, Ludwig; Bien, Siegfried; Bertalanffy, Helmut

doi:10.2176/nmc.44.68

Cited by 7 publications

(10 citation statements)

References 19 publications

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“…The aforementioned findings also demonstrated that TGN caused by bAVMs is a symptom of neurovascular compression, caused by the pulsatile compression of vessels. Pulsatile compression of the vessels may be caused by the feeding arteries of bAVMs, arterialized draining veins or malformation niduses ( 38 , 40 , 43 ). Among the 40 patients evaluated ( 4 , 12 , 14 – 40 ), there were 27 patients ( 4 , 12 , 15 , 19 , 21 , 24 – 29 , 31 , 34 – 40 ) in whom TGN was demonstrated to originate from vascular compression as determined by angiography or during the surgical procedure.…”

Section: Discussionmentioning

confidence: 99%

“…MVD surgery of the TG nerve is >90% effective and is capable of preserving neurological function relatively well; thus, MVD surgery has become the first choice of surgical treatment for primary TGN ( 45 ). Furthermore, bAVMs in the CPA, and even malformed niduses in the TG nerve, may not necessarily result in TGN ( 39 , 43 , 46 ). Therefore, focusing on complete resection of bAVMs as the predominant therapeutic option may cause further complications.…”

Section: Discussionmentioning

confidence: 99%

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Trigeminal neuralgia caused by brain arteriovenous malformations: A case report and literature review

Yuan

Zhang

Luo

et al. 2016

Experimental and Therapeutic Medicine

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Few cases of trigeminal neuralgia (TGN) induced by brain arteriovenous malformations (bAVMs) have previously been reported. The present case report described one case of TGN caused by bAVMs in a 32-year-old male patient who suffered from recurrent pain in his right cheek for a period of two years, for whom the seizure frequency and duration of pain increased for 6 months. Magnetic resonance imaging was performed, which demonstrated flow-void signals in the abnormal vessels in the right cerebellopontine angle. Subsequent digital subtraction angiography confirmed the diagnosis of bAVMs, and showed the nidus was fed by the right superior cerebellar and the right anterior inferior cerebellar, and drained into the adjacent venous sinuses on the same side. The patient underwent an interventional embolization treatment. TGN was completely relieved following embolization of the majority of the bAVMs. Pain relief may be associated with blocking of the pulsatile compression of the feeding arteries of the bAVMs, the arterialized draining veins or the malformed niduses following embolization, which is similar to the effects induced by microvascular decompression surgery of the trigeminal nerve. In the present case study and review, the underlying mechanism and treatment strategy of TGN caused by bAVMs were discussed in the context of present case, and a literature review was carried out.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Trigeminal neuralgia caused by brain arteriovenous malformations: A case report and literature review

Yuan

Zhang

Luo

et al. 2016

Experimental and Therapeutic Medicine

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“…18 The other patient presented with SAH with no accompanying neurological deficits, but facial hypesthesia developed after the resection. 16 Han et al recently reported the results of microsurgery for brainstem AVMs, categorizing them into 6 types. 9 The CPAC AVMs might be included in their lateral pontine type, which sits on the pial surface between the trigeminal nerve root medially and the cerebellopontine fissure laterally.…”

Section: Treatment Optionsmentioning

confidence: 99%

“…As shown in Table 2, CPAC AVMs presenting with neurovascular compression syndromes have been primarily managed by microsurgery; however, resection of the AVM frequently resulted in nerve root injury. 5,16,18 On this subject, preoperative MRI (including TOF and CISS imaging) is likely to provide useful information for determining the nidus-nerve relationship. In cases in which symptoms are caused by feeders or draining vessels compressing the nerve root, vascular decompression followed by GKS seems to be a reasonable treatment.…”

Section: Treatment Optionsmentioning

confidence: 99%

Clinical characteristics of arteriovenous malformations in the cerebellopontine angle cistern

Nishino

Hasegawa

Morita

et al. 2017

JNS

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OBJECTIVE Arteriovenous malformations (AVMs) in the cerebellopontine angle cistern (CPAC) are specific lesions that can cause neurovascular compression syndromes as well as intracranial hemorrhage. Although case reports describing the CPAC AVMs, especially those presenting with trigeminal neuralgia (TN), have been accumulating by degrees, the pathophysiology of CPAC AVMs remains obscure. The authors' purpose in the present study was to evaluate the clinical and radiographic features of CPAC AVMs as well as the treatment options. METHODS This study defined a CPAC AVM as a small AVM predominantly located in the CPAC with minimal extension into the pial surface of the brainstem and closely associated with cranial nerves. All patients with CPAC AVMs treated in the authors' affiliated hospitals over a 16-year period were retrospectively identified. Clinical charts, imaging studies, and treatment options were evaluated. RESULTS Ten patients (6 men and 4 women), ranging in age from 56 to 77 years (mean 65.6 years), were diagnosed with CPAC AVMs according to the authors' definition. Six patients presented with hemorrhage, 3 with TN, and the remaining patient developed a hemorrhage subsequent to TN. Seven AVMs were associated with the trigeminal nerve (Group V), and 3 with the facial-vestibulocochlear nerve complex (Group VII-VIII). All patients in Group VII-VIII presented with the hemorrhage instead of hemifacial spasm. Regarding angioarchitecture, the intrinsic pontine arteries provided the blood supply for all CPAC AVMs in Group V. In addition, 5 of 7 AVMs with hemorrhagic episodes accompanied flow-related aneurysms, although no aneurysm was detected in patients with TN alone. With respect to treatment, all patients with hemorrhagic presentation underwent Gamma Knife surgery (GKS), resulting in favorable outcomes except for 1 patient who experienced rebleeding after GKS, which was caused by the repeated rupture of a feeder aneurysm. The AVMs causing TN were managed with surgery, GKS, or a combination, according to the nidus-nerve relationship. All patients eventually obtained pain relief. CONCLUSIONS Clinical symptoms caused by CPAC AVMs occur at an older age compared with AVMs in other locations; CPAC AVMs also have distinctive angioarchitectures according to their location in the CPAC. Although GKS is likely to be an effective treatment option for the CPAC AVMs with hemorrhagic presentations, it seems ideal to obliterate the flow-related aneurysms before performing GKS, although this is frequently challenging. For CPAC AVMs with TN, it is important to evaluate the nidus-nerve relationship before treatment, and GKS is especially useful for patients who do not require urgent pain relief.

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“…Their clinical manifestation includes hemorrhage, mass effect, or neurovascular compression syndrome. [2][3][4][5][6][7][8] These lesions can be treated with a less invasive strategy, such as Gamma Knife or endovascular embolization.…”

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confidence: 99%

Arteriovenous malformation of the trigeminal nerve root presented with venous congestive edema of the medulla oblongata and upper cervical cord: illustrative case

Nagai

Endo

Sato

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND Arteriovenous malformation (AVM) of the trigeminal nerve root (TNR) is a rare subtype of the lateral pontine AVM. Most of them are diagnosed when they bleed or exert trigeminal neuralgia. Venous congestive edema is a rare phenomenon caused by TNR AVMs. OBSERVATIONS An 82-year-old man was admitted with progressive limb weakness and dysphasia. Magnetic resonance imaging (MRI) revealed extensive edema of the medulla oblongata and the upper cervical cord with signal flow void at the C3 anterior spinal cord. Vertebral angiography revealed a small nidus fed mainly by the pontine perforating arteries (PPAs). The anterior pontomesencephalic vein (AMPV) was dilated, functioning as the main drainage route. This suggests that venous hypertension triggered the brainstem and upper cervical cord edema. MRI with gadolinium enhancement showed that the nidus was located around the right TNR. Because the nidus sat extrinsically on the pial surface of the right TNR’s base, microsurgical obliteration with minimum parenchymal injury was achieved. Postoperative MRI showed disappearance of the brainstem and cervical cord edema with improved clinical symptoms. LESSONS TNR AVM is rarely associated with brainstem and upper cervical cord edema caused by venous hypertension of the congestive drainage system.

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Arteriovenous Malformation Surrounding the Trigeminal Nerve-Case Report-

Cited by 7 publications

References 19 publications

Trigeminal neuralgia caused by brain arteriovenous malformations: A case report and literature review

Trigeminal neuralgia caused by brain arteriovenous malformations: A case report and literature review

Clinical characteristics of arteriovenous malformations in the cerebellopontine angle cistern

Arteriovenous malformation of the trigeminal nerve root presented with venous congestive edema of the medulla oblongata and upper cervical cord: illustrative case

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