Intrinsic Arteriovenous Malformation Embedded in the Trigeminal Nerve of a Patient With Trigeminal Neuralgia -Case Report-

Abstract

A 66-year-old man presented with typical right trigeminal neuralgia. Neuroimaging showed a small arteriovenous malformation (AVM) in the right cerebellopontine angle. Suboccipital craniotomy verified that the AVM was almost completely embedded in the root entry zone of the trigeminal nerve and the nerve axis was tilted infero-posteriorly. The patient obtained complete pain relief without sequelae after surgery by transposition of the superior cerebellar artery and correction of the tilted nerve axis. The nidus of the unresected AVM was obliterated by gamma knife radiosurgery.

Remission of neurovascular conflicts in the cerebellopontine angle in interventional neuroradiology

“…The goal of treatment in these situations is to relieve the symptoms and to lessen the risk of future hemorrhage. Different approaches for these lesions associated with NVCs have been reported 3 4 7–25. To decide the optimal treatment strategy for each patient, the location of the offending lesions (IA or AVM nidus itself, dilated feeding artery, or dilated draining vein), severity of symptoms, and the risk versus benefit of treatment are to be considered.…”

“…Hence, the surgical risk of complications should be weighed against the benefit, carefully considering the complex anatomy of the posterior cranial fossa and the feasibility of the surgery. Radiosurgery is a possible treatment option for some intracranial AVMs such as intrinsic AVMs of the cranial nerve itself,3 4 although the patient will still be exposed to hemorrhagic risk during the time to obliteration.…”

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

“…Excluding two patients for whom the information was incomplete ( 27 , 33 ), there were 24 male and 14 female patients (male:female ratio, ~1.71) aged between 23 and 69 years with a mean age of 46.8±14.7 years. These patients presented with bAVMs located in the CPA (n=19)( 12 , 16 , 17 , 20 , 23 , 27 – 33 , 36 , 38 ), cerebellar hemisphere (n=8)( 15 , 18 , 21 , 26 , 34 , 35 , 40 ), the TG nerve (n=7)( 22 , 25 , 39 ), the cerebellar vermis (n=3)( 4 , 14 , 24 ), the pontine (n=1)( 37 ), the septum pellucidum (n=1)( 19 ) and both the cerebellar hemisphere and cerebellar vermis (n=1)( 38 ) ( Fig. 3 ).…”

“…In terms of treatment, 2 patients received drug therapy ( 17 ) and 1 patient was without mention of treatment ( 12 ). The other 37 patients received non-drug treatment ( 4 , 14 – 40 ), 11 patients received surgical resection alone ( 19 , 25 , 27 – 30 , 32 ), 2 patients received surgical resection following partial embolization ( 23 , 26 ), 1 patient received surgical resection following destructive neurosurgical manipulation of the TG nerve( 31 ), 3 patients received surgical resection of bAVMs combined with microvascular decompression (MVD; 14,15,18,20,24), 5 patients received an interventional embolization treatment, 2 patients received radiotherapy following embolization ( 4 , 21 ), 6 patients received MVD treatment alone ( 37 – 39 ), 2 patients received radiotherapy following MVD ( 36 , 40 ), 4 patients received destructive neurosurgical manipulation of the TG nerve ( 16 , 17 , 33 , 38 ), and 1 patient received stereotactic radiotherapy (SRS; 22) ( Fig. 4 ).…”

Trigeminal neuralgia due to arterialization of the superior petrosal vein in the context of dural or cerebral arteriovenous shunt

“…2 The association between trigeminal neuralgia and arteriovenous shunt of cerebrum or dura has been reported in few cases only. [3][4][5][6][7][8][9][10][11][12][13][14][15][16] Isolated cases reported good pain reversibility after embolization, 4,7,8,10,13, 15 surgery 2, 5, 6 or radiotherapy. 3,11,16 We report our cases of symptomatic trigeminal neuralgia secondary to brain arteriovenous malformation (bAVM) or dural arteriovenous fistula (DAVF) in order to understand the pathophysiology, the structure that compresses the nerve (in case of compression) and factors influencing the presence of the neuralgia.…”