Resolution of Trigeminal Neuralgia Following Cerebellar AVM Embolization With Onyx

Abstract

Intracranial arteriovenous malformation (AVM) is a rare cause of trigeminal neuralgia (TN). Successful resolution of AVM-related TN following embolization surgery using Onyx has not been reported. In this case report, a posterior fossa AVM was embolized in two separate, staged endovascular surgeries using Onyx. The AVM was reduced in size, and the TN resolved. The patient subsequently underwent radiosurgery for the small, residual AVM, and he has maintained an uneventful follow-up. A thorough literature review was also performed for AVM-associated TN. Fifty-nine reports of AVM-related TN have been described to date, of which only three were treated with embosurgery. None of the prior two embosurgical reports utilized Onyx, and no AVM was obliterated with embosurgery alone. TN secondary to AVM can be resolved with embosurgery utilizing Onyx; however, complete elimination of the underlying AVM requires adjuvant surgery.

Endovascular Palliation of AVM-Associated Intractable Trigeminal Neuralgia via Embolization of the Artery of the Foramen Rotundum

“…In AVM‐associated TN, similar symptoms are thought to arise from the nerve's contact with abnormal vascular structures of the AVM [3] (as in the earlier case), micro‐AVMs intrinsic to the nerve or brainstem [8], or arterialized veins in the nerve's vicinity [5]. Recent reports of embolization of posterior fossa AVMs [18,19,21,26] and dAVFs [6] have shown promise in treating AVM‐associated TN, suggesting an endovascular analog to microvascular decompression.…”

“…Treatment of AVM‐associated TN has included standalone or combination therapy consisting of percutaneous procedures (thermocoagulation, balloon compression, or glycerol injection) [1,2,8–12], surgical microvascular decompression, or AVM extirpation [3,5,7,8,13,14], and stereotactic radiosurgery [15–17]. Recently, endovascular embolization of aberrant vasculature has emerged as a treatment strategy for AVM‐associated TN [6,18–21]. We report a case of a child with TN from a large posterior fossa AVM in whom repeated embolization of vascular feeders in contact with the V2 division provided only temporary relief.…”

A Case of High-grade Arteriovenous Malformation Manifesting as Trigeminal Neuralgia Successfully Treated by Embolization in Multimodal Treatment

“…It has been reported that treatment of nidus reduced blood flow and the size of the feeder, which resolved pulsatile compression of the trigeminal nerve and remitted TGN. 4, [9][10][11][12][13] Since the present case had high-grade AVM, nidus treatment was included in multimodal treatment aiming at elimination of the hemorrhagic risk and treatment of TGN. It was planned to perform excision after multistage embolization and add MVD as the (PCA), and anterior choroidal artery, and the drainers were the great cerebral vein of Galen, basal vein of Rosenthal, and vein of Labbe, and the condition was Spetzler-Martin (SM) grading scale Grade IV (Figs.…”

“…When symptoms are not improved by multimodal treatment, application of MVD should be investigated. Other than direct surgery, it has been occasionally reported that (7) SRS alone was effective, 8) (8) embolization alone was effective, [10][11][12][13] and (9) SRS was performed after embolization. 9) When the risks of excision and MVD are expected to be high, noninvasive modalities, such as SRS and embolization, may be investigated.…”

“…Symptomatic treatment with drugs, such as carbamazepine, and stereotactic radiosurgery (SRS) with gamma knife are performed, and microvascular decompression (MVD) is performed as radical treatment. 1) Cerebral arteriovenous malformation (AVM) rarely causes TGN, and many cases treated with direct surgery 2-7) and SRS 8,9) have been reported, but cases treated with embolization 4, [9][10][11][12][13] have also been occasionally reported. We encountered a rare case of high-grade AVM which manifested as TGN.…”