Venous angioma adjacent to the root entry zone of the trigeminal nerve: implications for management of trigeminal neuralgia

Abstract

Detection of a venous angioma at the root entry zone is important for surgical planning, so that the neurosurgeon will be aware that both veins and arteries may require microvascular decompression. In selected cases, alternative treatment may be indicated to avoid the potential surgical complication of a venous infarct. Trigeminal neuralgia typically occurs in the middle-aged to elderly population, usually the result of compression of the trigeminal nerve at its root entry zone by an ectatic, aging artery or, less commonly, a regional vein [1, 2, 3]. When associated with a venous angioma at the root entry zone, trigeminal neuralgia usually presents at a younger age [4, 5, 6]. We review the imaging examinations and clinical data of five patients with trigeminal neuralgia who had a venous angioma adjacent to the root entry zone of the trigeminal nerve, and discuss how the imaging findings affected their management.

Trigeminal Neuralgia Caused by Venous Angioma

“…Consequently, glycerol rhizotomy could be one of the important surgical options for the preservation of the venous system during MVD. 12) In the present case, the possibility that normal arteries such as the superior cerebellar artery or the anterior inferior cerebellar artery were the offending vessel could not be completely denied, although this was most unlikely with the abnormally dilated veins compressing the REZ. Surgery is the most definitive option to clarify the offending structure.…”

“…Previous case reports of trigeminal neuralgia caused by venous malformation are presented in Table 1. 4,7,8,11,12) Patients with trigeminal neuralgia caused by venous angioma tend to be younger than those with typical trigeminal neuralgia. The offending vessel is quite easy to identify with modern imaging methods without the need for invasive conventional angiography.…”

Gamma Knife Stereotactic Radiosurgery for Trigeminal Neuralgia Caused by a Developmental Venous Anomaly

“…This is compared to a 0.2% mortality rate for a large series of patients with a typical etiology [19]. Indeed, in the rhizotomy case, the operating surgeon avoided MVD for fear of disrupting the large brachium pontis DVA causing the patients symptoms and achieved complete pain relief in doing so [11]. …”

“…To our knowledge, there appear to be only 20 total reported cases [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16]. Although microvascular decompression (MVD) is the favored surgical treatment of refractory TN, surgical disruption of a DVA can lead to severe neurological deficits or even death due to venous infarction [16].…”

Trigeminal Neuralgia Caused by Venous Angioma: A Case Report and Review of the Literature

“…Most cases of neurovascular compression of the root entry zone are seen in middle-aged to elderly patients and are caused by an ectatic regional artery or, less commonly, a regional vein (3,5,13).…”