Trigeminal Neuralgia in a Patient with a Dural Arteriovenous Fistula in Meckel's Cave: Case Report

Abstract

Trigeminal neuralgia may be associated with complex vascular lesions around the base of the brain and along the course of the trigeminal nerve. The evaluation of patients with trigeminal neuralgia should include high-quality, thin-section, magnetic resonance imaging scans, to exclude the possibility of vascular lesions and other structural lesions. In particular, patients who are being evaluated for surgical treatment of trigeminal neuralgia should undergo magnetic resonance imaging, with a focus on the course of the trigeminal nerve.

Bony anomaly of Meckel's cave

“…The foramen in our case measured 5 3 2.5 mm and the width of the adult trigeminal nerve at this site ranges from 2-6 mm (Lang, 1991); therefore, this nerve could have been potentially compressed here. Compression of the trigeminal nerve in Meckel's cave has been found to cause trigeminal neuralgia and trigeminal neuropathy (Du et al, 2003). Some have found other bony anomalies of skull base that were thought to contribute to the symptoms of trigeminal neuralgia such as familial osteodysplasia (Niijima et al, 1984) and asymmetry of the petrous portion of the temporal bone (Obrador et al, 1970;Takada et al, 2001) Interestingly, Taarnhøj (1952) has advocated decompression only of the dura mater that forms Meckel's cave in treating trigeminal neuralgia stating that often merely the dural compression at this site was sufficient to create pathology.…”

Pituitary Adenoma Presenting As Trigeminal Neuralgia

“…Various tumors have been known to cause trigeminal neuralgia by compression of nerve which includes schwanoma, lipoma, epidermoid, meningioma, chordoma, granuloma, metastasis, and glioblastoma. [2][3][4][5] Among all the tumors, compression of trigeminal nerve or its one or more divisions in cavernous sinus by pituitary adenoma is a rare entity. On literature search in PubMed and Medline, we could find only one case of pituitary adenoma compressing V1, V2 in cavernous sinus and leading to trigeminal neuralgia.…”

Tentorial dural arteriovenous fistula manifesting as contralateral trigeminal neuralgia: resolution after transarterial Onyx embolization

“…Secondary trigeminal neuralgia, although not common, may be due to tumors, aneurysms, vascular malformations, or vertebrobasilar artery ectasia 1. Dural arteriovenous fistulas (DAVFs) remain a rare cause of trigeminal neuralgia with less than 10 cases reported in the literature 1–9.…”