Trigeminal Neuralgia Caused by Nerve Compression by Dilated Superior Cerebellar Artery Associated with Cerebellar Arteriovenous Malformation: Case Report

Abstract

Intracranial arteriovenous malformation (AVM) is a rare cause of trigeminal neuralgia (TGN). In this presented case, successful resolution of AVM-related TGN following embolization and gamma knife radiosurgery (GKRS) was obtained. A patient suffered from TGN on the left side, which was thought to be caused by root entry zone compression by dilated superior cerebellar artery (SCA) associated with cerebellar AVM. The cerebellar vermis AVM was embolized in endovascular surgery. The AVM was reduced in size and TGN was partially relieved. The patient subsequently underwent GKRS for the residual nidus. TGN was completely resolved within one year and a half. GKRS following embolization of the nidus improved the flow-related dilation of the SCA and completely relieved TGN.

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

“…nerve and remits TGN relatively early, suggesting the efficacy of embolization. [9][10][11][12][13] Yuan et al 13) reported that TGN completely resolved 1 week after treatment. It has been reported that even when the responsible blood vessel is a dilated drainer, a similar symptom-improving effect of embolization was acquired.…”

“…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.…”

“…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. TGN may also be resolved in cases which may be cured by embolization alone.…”

“…11) In another reported case, the addition of treatment other than excision to embolization improved symptoms. Mori et al 9) reported a case in which symptoms remitted after embolization, subsequently SRS was applied to nidus, and the symptoms disappeared, concluding that this was due to remission of dilatation of the SCA, the responsible blood vessel, with regression of nidus. In the present case, visualization through the posterior circulation disappeared after the 4th embolization and then TGN completely resolved after 1.5 months.…”

“…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.…”