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

Abstract

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.

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.…”

Tics in TACs: A Step into an Avalanche? Systematic Literature Review and Conclusions

“…Comparing secondary SUNCT/SUNA to ICHD‐3 beta painful trigeminal neuropathy, in other words “secondary TN,” there is some overlap, eg, with respect to herpes zoster, MS and trauma . In addition, arteriovenous malformations, brainstem ischemia, and vertebral artery dissection, as well as Chiari I malformation have also been reported in TN . The most striking difference is found for pituitary adenomas which were associated with SUNCT but do not cause TN.…”

Aplicação de Toxina Botulínica Tipo A para Redução da Dor na Neuralgia Trigeminal – 6 meses de acompanhamento

“…There are also some factors that may be associated with TN, such as multiple sclerosis, viral infection, and anatomical abnormalities that compress the trigeminal ganglion; Another commonly reported factor is vessel compression at the nerve root entrance causing demyelination of sensory fibers of the trigeminal nerve. 18,19,20 Conventional treatments for TN include administration of drugs or therapeutic approach with microvascular decompression surgery, even though surgery is a more invasive approach. 17,21,22 However, according to Santos et.…”