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Dai X, Xu D, Chen K, Cai Y, Mei Z, Wu J, Shen L, Yang J, Xiong N. Dural arteriovenous fistula presenting as trigeminal neuralgia: Case report and literature review. Heliyon 2024; 10:e30000. [PMID: 38694083 PMCID: PMC11058893 DOI: 10.1016/j.heliyon.2024.e30000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 05/03/2024] Open
Abstract
Background Trigeminal neuralgia (TN) secondary to a dural arteriovenous fistula (DAVF) is quite rare, and the goal of treatment is to resolve both the fistula and the pain. Case presentation We herein report a case of TN secondary to a DAVF in a 64-year-old woman with a 1-year history of right-sided TN. Brain magnetic resonance imaging and digital subtraction angiography showed a right tentorial DAVF. Interventional embolization was performed, but the pain was not relieved after the operation. Six months later, we performed microvascular decompression of the trigeminal nerve. During the operation, we electrocoagulated the tortuous and dilated malformed vein, which was compressing the trigeminal nerve, to reduce its diameter and mitigate the compression on the cisternal segment of the trigeminal nerve. That patient's pain was relieved postoperatively. In addition, we reviewed the literature of TN caused by DAVF and found a total of 30 cases, 22 of which were treated by interventional embolization. Of these 22 cases, the interventional embolization healed the fistula with pain relief in 14 cases and healed the fistula without pain relief in 8 cases. We found that the venous drainage methods of the 8 cases were all classified into the posterior mesencephalic group. Conclusions We believe that this drainage pattern contributes to the more common occurrence of unrelieved pain. For such patients, microvascular decompression can be performed with intraoperative coagulation to narrow the dilated veins until the cisternal segment of the trigeminal nerve is no longer compressed. Satisfactory curative effects can be obtained using this technique.
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Affiliation(s)
| | | | - Keyu Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Yuankun Cai
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Zhimin Mei
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Ji Wu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Lei Shen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Jingyi Yang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Nanxiang Xiong
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
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2
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Comert A, Dogan I, Cavdar Yilmaz NP, Gungor Y, Bekdemir Y, Kubat G, Gurpinar S, Basarmak MB, Asan B, Gul D, Gokmen D. Investigating the Effects of Trigeminal Impression and Internal Acoustic Opening Morphology Differences for Possible Surgical Applications. World Neurosurg 2024; 181:e84-e93. [PMID: 37562683 DOI: 10.1016/j.wneu.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE The exhaustive information regarding the types of trigeminal pore (TP) or trigeminal impression (TI), internal acoustic opening (IAO), and related surgical approaches is lacking in the literature. Therefore, this study is performed to further elucidate the types of TP or TI, IAO, and the relationships with critical surgical landmarks in the skull base. METHODS Trigeminal impression (TI) and internal acoustic opening (IAO) found in 11 dry skulls, 24 right temporal bones, and 25 left temporal bones were examined on both sides to define their relationship to each other and nearby structures. The age and sex of these bones were not identified. Besides these, 77 skulls were examined by radiologic imaging methods. These skulls were identified by gender. RESULTS According to test results, there was a significant difference between the left and right internal acoustic opening in the case of horizontal dimension (HD). The left HD-IAO is bigger than the right one. In addition, right HD-IAO, vertical dimension (VD) of right internal acoustic opening, left HD-IAO, and left VD-IAO values differed significantly in male and female patients. CONCLUSIONS Investigating the relationship of TI and IAO with relevant structures suggests that surgical approaches involving the TP and IAO indicated that surgical approaches considering the TI and IAO variations may be used in the development of surgical processes and primary surgical interventions.
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Affiliation(s)
- Ayhan Comert
- Department of Anatomy, School of Medicine, Ankara University, Ankara, Turkey.
| | - Ihsan Dogan
- Department of Neurosurgery, School of Medicine, Ankara University, Ankara, Turkey; Department of Anatomy, Ankara University Graduate School of Health Science, Ankara, Turkey
| | | | - Yigit Gungor
- Department of Anatomy, School of Medicine, Ankara University, Ankara, Turkey
| | | | - Goktug Kubat
- School of Medicine, Ankara University, Ankara, Turkey
| | | | | | - Batuhan Asan
- School of Medicine, Ankara University, Ankara, Turkey
| | - Dicle Gul
- School of Medicine, Ankara University, Ankara, Turkey
| | - Derya Gokmen
- Department of Biostatistics, School of Medicine, Ankara University, Ankara, Turkey
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Zhou H, Wei X, Zeng D, Zhang S, Hu X, Wei Z, Li Y. Trigeminal neuralgia associated with dural arteriovenous fistula: a case report and literature reviews. Front Neurol 2023; 14:1293056. [PMID: 38130833 PMCID: PMC10734301 DOI: 10.3389/fneur.2023.1293056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/30/2023] [Indexed: 12/23/2023] Open
Abstract
Trigeminal neuralgia is a paroxysmal, intense electric shock-like, or knife-like, recurrent pain that affects one or more sense areas of the unilateral facial trigeminal nerve. It can be classified into two groups from an etiological standpoint: primary and secondary. The pain episodes brought on by such vascular compression are still categorized as primary trigeminal neuralgia, despite the fact that microvascular compression of the trigeminal nerve root has now been demonstrated to be the primary cause. A rare and complicated condition known as a dural arteriovenous fistula (DAVF) can irritate the Gasserian ganglion or compress the trigeminal nerve's root entry zone (REZ), leading to secondary trigeminal neuralgia (TN). At present, the treatment of DAVF-induced trigeminal neuralgia is not conclusive. This article reports a case of DAVF-induced trigeminal neuralgia cured by MVD and reviews the relevant literature.
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Affiliation(s)
- Hao Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
- Department of Graduate School, Dalian Medical University, Dalian, China
| | - Xingrong Wei
- Department of Neurosurgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
- Department of Graduate School, Dalian Medical University, Dalian, China
| | - Defeng Zeng
- Department of Neurosurgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
- Department of Graduate School, Dalian Medical University, Dalian, China
| | - Shuguang Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xueqian Hu
- Department of Neurosurgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
- Department of Graduate School, Dalian Medical University, Dalian, China
| | - Zhenqin Wei
- Department of Neurosurgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yang Li
- Department of Neurosurgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Mulcahy T, Ma N, Mitchell K. Endovascular treatment of trigeminal neuralgia with cranial autonomic symptoms due to a right-sided petrous ridge dAVF. Br J Neurosurg 2023; 37:1339-1345. [PMID: 33467937 DOI: 10.1080/02688697.2021.1874295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
Dural arteriovenous fistula represents a rare cause of secondary Trigeminal Neuralgia. To date, there have been 18 reported cases of successful treatment of trigeminal neuralgia with endovascular embolization. Here we describe a unique case of a 51-year-old man with right-sided petrous ridge dural arteriovenous fistula causing ipsilateral V1 pain and cranial autonomic dysfunction. Cerebral angiography confirmed a Cognard type 3 right-sided tentorial dAVF supplied by an enlarged meningo-hypophpyseal vessel from the extradural ICA and by the middle meningeal artery. The fistula drains towards the midline via deep cerebral veins, the internal cerebral vein and the straight sinus with likely variceal compression of the right trigeminal nerve root entry zone. Transarterial Onyx embolization resulted in complete obliteration of the dural arteriovenous fistula with immediate resolution of facial pain and autonomic symptoms. After 24 months, the patient remains symptom-free and has no radiographic or clinical evidence of fistula recurrence. To date, there have been no other cases reported of trigeminal neuralgia with cranial autonomic symptoms or SUNCT syndrome due to a dural arteriovenous fistula. The presence of cranial autonomic symptoms with trigeminal neuralgia or a diagnosis of SUNCT should not deter endovascular treatments of dural arteriovenous fistulas or treatment of other compressive vascular lesions.
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Affiliation(s)
- Thomas Mulcahy
- Department of Neurosurgery, Royal Brisbane and Women's Hospital, Herston, Australia
- School of Clinical Medicine, The University of Queensland, Brisbane, Australia
| | - Norman Ma
- Department of Neurosurgery, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Kenneth Mitchell
- Department of Interventional Radiology, Royal Brisbane and Women's Hospital, Herston, Australia
- School of Medicine, The University of Queensland, Brisbane, Australia
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Yamauchi K, Hori T, Morishima R, Matsuda A, Sakai H. Trigeminal Neuralgia Caused by Dural Arteriovenous Fistula of the Transverse-Sigmoid Sinus without Vessel Compression at Root Entry Zone. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 16:170-174. [PMID: 37502279 PMCID: PMC10370785 DOI: 10.5797/jnet.cr.2021-0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/11/2021] [Indexed: 07/29/2023]
Abstract
Objective The vessel compression at the root entry zone (REZ) of trigeminal nerve is a common cause of trigeminal neuralgia (TN). We report a rare case of TN caused by dural arteriovenous fistula (DAVF) of the transverse-sigmoid sinus without vessel compression at REZ. Case Presentation A 45-year-old woman presented with right side tinnitus and was diagnosed as a DAVF of the right transverse-sigmoid sinus (Borden Type I). After that, the facial pain in the right maxillary nerve area appeared and was getting worse. DSA revealed an enlargement of the artery of foramen rotundum (AFR) as one of the feeding arteries. MRI revealed no evidence of vascular compression at REZ. The patient was treated with transarterial embolization (TAE) with Onyx via the branches of the middle meningeal artery (MMA) and occipital artery (OA). The AFR decreased in size and the facial pain was improved. However, the DAVF and the facial pain were recurred. Finally, the DAVF was completely embolized with transvenous embolization (TVE). During 1-year follow-up period, the patient remained free of pain without recurrence. Conclusion The compression of the maxillary nerve by the AFR might result in TN, because the pain diminished after shrinkage of the AFR by the endovascular treatment.
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Affiliation(s)
- Keita Yamauchi
- Department of Neurosurgery, National Hospital Organization Toyohashi Medical Center, Toyohashi, Aichi, Japan
| | - Takamitsu Hori
- Department of Neurosurgery, National Hospital Organization Toyohashi Medical Center, Toyohashi, Aichi, Japan
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan
| | - Ryo Morishima
- Department of Neurosurgery, National Hospital Organization Toyohashi Medical Center, Toyohashi, Aichi, Japan
| | - Akihide Matsuda
- Department of Neurosurgery, National Hospital Organization Toyohashi Medical Center, Toyohashi, Aichi, Japan
| | - Hideki Sakai
- Department of Neurosurgery, National Hospital Organization Toyohashi Medical Center, Toyohashi, Aichi, Japan
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Ogut E, Armagan K, Barut C. Reappraisal of the types of trigeminal porus and importance in surgical applications. Surg Radiol Anat 2021; 43:1169-1178. [DOI: https:/doi.org/10.1007/s00276-020-02651-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/05/2020] [Indexed: 07/22/2023]
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Ogut E, Armagan K, Barut C. Reappraisal of the types of trigeminal porus and importance in surgical applications. Surg Radiol Anat 2021; 43:1169-1178. [PMID: 33399922 DOI: 10.1007/s00276-020-02651-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/05/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The detailed information regarding the types of trigeminal porus (TP) and related surgical approach is lacking in the literature. Therefore, we performed this study to elucidate further the types of TP and the relationships with critical surgical landmarks in the skull base. METHODS The study was performed on 19 formalin-fixed cadavers of the cranial base (52.6% male, n = 10; 47.4% female, n = 9) on both sides. Calculations were made of the vertical dimension (VD), horizontal dimension (HD), and types of TP, the thickness of the TP, the HD and VD of the internal acoustic meatus, the distance between the TP-IAM, the thickness of the ossifying tissue that forms the TP, the trigeminal nerve (CN V) in both types and the distance between the CN V-VI. RESULTS The elliptical (42.1% left, 36.8% right), oval (52.6% left, 36.8% right) and slit-like (5.3% right) types of TP were detected (X2 = 11.722). The HD of the TP was, on average, 8.02 mm (female) and 9.2 mm (male) on the right side, and 8.26 mm (female) and 8.81 mm (male) on the left side. The VD of the TP was, on average, 1.99 mm (female) and 2.65 mm (male) on the right side, and 2.42 mm (female) and 2.94 mm (male) on the left side. CONCLUSIONS In our study, ellipse and slit-like types of TP are taken into account in order to plan the surgical approaches to remove or prevent the extension of tumors. A combined surgical technique is recommended to reach the TP easily without damaging the nearby surgical structures during surgery. The oval type of TP allows a wide range of movements, so it is more advantageous in skull base surgery.
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Affiliation(s)
- Eren Ogut
- Department of Anatomy, School of Medicine, Bahcesehir University, 34734, Istanbul, Turkey
| | - Kutay Armagan
- Medical Faculty Student, School of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Cagatay Barut
- Department of Anatomy, School of Medicine, Bahcesehir University, 34734, Istanbul, Turkey.
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Brown EC, Texakalidis P, Stedelin B, Tora MS, Rindler RS, Grossberg JA, Peterson RB, Campbell M, Cetas JS, Boulis NM, Raslan AM. Dural Arteriovenous Fistula Presenting as Trigeminal Neuralgia: 2 Case Reports and Review of the Literature. World Neurosurg 2020; 139:298-308. [DOI: 10.1016/j.wneu.2020.02.083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/12/2020] [Accepted: 02/14/2020] [Indexed: 11/24/2022]
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9
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Chen H, Chen R, Yang H, Li H, Wang J, Yu J. Resolution of Trigeminal Neuralgia After Surgical Disconnection of a Foramen Magnum Dural Arteriovenous Fistula. World Neurosurg 2020; 135:209-213. [DOI: 10.1016/j.wneu.2019.07.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 01/31/2023]
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10
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Cleary DR, Handwerker J, Ansari H, Ben-Haim S. Three Cases of Trigeminal Neuralgia with Radiographic Absence of Meckel's Cave. Stereotact Funct Neurosurg 2019; 97:249-254. [PMID: 31661697 DOI: 10.1159/000502564] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 08/08/2019] [Indexed: 11/19/2022]
Abstract
Trigeminal neuralgia (TN) is a debilitating but treatable disease. Classic TN has referable vascular compression of the trigeminal nerve, but rarely secondary sources of anatomic compression will present, including vascular malformations, aneurysms, or tumors. Understanding the etiology of the patients' symptoms leads to targeted treatment. Three patients presented with symptoms consistent with TN: shooting, paroxysmal pains in the distribution of the trigeminal nerve. However, imaging revealed no vascular conflict at the root entry zone of the trigeminal nerve. Instead, on the affected side Meckel's cave was absent. No other compressive mass lesion was identified. In all three cases, patients were offered both Gamma Knife Radiosurgery and surgical decompression of Meckel's cave. All 3 patients elected to proceed with stereotactic radiation and reported improvement in pain. Many cases of classic TN can be explained by neurovascular conflict at the trigeminal root entry zone, but secondary sources of compression or restriction along the nerve can result in similar symptomology. In this case series, an absent or hypoplastic ipsilateral Meckel's cave may have produced symptoms consistent with TN. Imaging with fine cuts through Meckel's cave is an important diagnostic tool.
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Affiliation(s)
- Daniel R Cleary
- Department of Neurological Surgery, University of California San Diego, San Diego, California, USA
| | - Jason Handwerker
- Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Hossein Ansari
- Department of Neurosciences, University of California San Diego, San Diego, California, USA
| | - Sharona Ben-Haim
- Department of Neurological Surgery, University of California San Diego, San Diego, California, USA,
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Dupont G, Altafulla J, Iwanaga J, Watanabe K, Tubbs RS. Ossification of the roof of the porus trigeminus with duplicated abducens nerve. Anat Cell Biol 2019; 52:211-213. [PMID: 31338240 PMCID: PMC6624332 DOI: 10.5115/acb.2019.52.2.211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 11/27/2022] Open
Abstract
Ossification of parts of the intracranial dura mater is common and is generally accepted as an age-related finding. Additionally, duplication of the abducens nerve along its course to the lateral rectus muscle is a known, although uncommon anatomical variant. During routine cadaveric dissection, an ossified portion of dura mater traveling over the trigeminal nerve's entrance (porus trigeminus) into the middle cranial fossa was observed unilaterally. Ipsilaterally, a duplicated abducens nerve was also observed, with a unique foramen superolateral to the entrance of Dorello's canal. To our knowledge, there has been no existing report of a simultaneous ossified roof of the porus trigeminus with an ipsilateral duplicated abducens nerve. Herein, we discuss this case and the potential clinical and surgical applications. We believe this case report will be informative for the skull base surgeon in the diagnosis of neuralgic pain in the frontomaxillary, andibular, orbital, and external and middle ear regions.
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Affiliation(s)
| | - Juan Altafulla
- Seattle Science Foundation, Seattle, WA, USA.,Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
| | - Joe Iwanaga
- Seattle Science Foundation, Seattle, WA, USA.,Seattle Science Foundation, Seattle, WA, USA
| | - Koichi Watanabe
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Japan
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, WA, USA.,Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
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Okromelidze L, Vilanilam G, Gupta V, Trifiletti DM, Brown BL, Middlebrooks EH. Trigeminal Neuralgia Caused by Dural Arteriovenous Fistula in Meckel Cave Treated with Gamma Knife Radiosurgery. World Neurosurg 2019; 122:607-612. [DOI: 10.1016/j.wneu.2018.11.177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 11/17/2018] [Accepted: 11/19/2018] [Indexed: 10/27/2022]
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Fukutome K, Nakagawa I, Park HS, Wada T, Motoyama Y, Kichikawa K, Nakase H. Resolution of Trigeminal Neuralgia After Transvenous Embolization of a Cavernous Sinus Dural Arteriovenous Fistula. World Neurosurg 2017; 98:880.e5-880.e8. [DOI: 10.1016/j.wneu.2016.11.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 11/05/2016] [Accepted: 11/07/2016] [Indexed: 11/16/2022]
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14
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Shuhui G, Jiagang L, Siqing H, Haifeng C, Qingrong T, Bohao Z. Rare Cervical Intramedullary Cavernous Angioma with Trigeminal Neuralgia and Cervical Itch: Case Report and Review of the Literature. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e25151. [PMID: 28191336 PMCID: PMC5292155 DOI: 10.5812/ircmj.25151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 04/26/2015] [Accepted: 06/06/2015] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Intramedullary cavernous angioma (ICA) is a rare lesion of the spinal cord, representing only 3% - 5% of central nervous system lesions. The coexistence of trigeminal neuralgia and refractory itch is very rarely encountered in clinical practice. To our knowledge, a report of an ICA with trigeminal neuralgia and local neuropathic itch has never been published to date. Thus, we present a very interesting case of a C2 ICA. CASE PRESENTATION A 61-year-old female presented with right facial pain for three years, which was exacerbated by accompanying cervical pain and itch for one month. The patient's symptoms were relieved after surgery, and there was no recurrence of lesions one year later. CONCLUSIONS ICA with trigeminal neuralgia and local neuropathic itch is very rarely encountered in clinical practice. As it is not always diagnosed at first, some patients miss the best treatment period. Therefore, we call for emphasis to be placed on early diagnosis and timely surgical treatment.
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Affiliation(s)
- Gong Shuhui
- Department of Neurosurgery, Sichuan University, West China Hospital, P. R. China
| | - Liu Jiagang
- Department of Neurosurgery, Sichuan University, West China Hospital, P. R. China
| | - Huang Siqing
- Department of Neurosurgery, Sichuan University, West China Hospital, P. R. China
| | - Chen Haifeng
- Department of Neurosurgery, Sichuan University, West China Hospital, P. R. China
| | - Tang Qingrong
- The Third People’s Hospital of Shenzhen, Shenzhen, P. R. China
| | - Zhao Bohao
- Department of Neurosurgery, Sichuan University, West China Hospital, P. R. China
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Ge H, Lv X, Jin H, He H, Li Y. Role of endovascular embolization for trigeminal neuralgia related to cerebral vascular malformation. Interv Neuroradiol 2016; 22:600-5. [PMID: 27402800 PMCID: PMC5072218 DOI: 10.1177/1591019916654430] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 05/06/2016] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The objective of this article is to describe the trigeminal neuralgia related to cerebral vascular malformation that is rarely reported and the experience referring to endovascular treatment. PATIENTS AND METHODS A total of 10 patients who had cerebral vascular malformation (AVM and dAVF) in a single center presented with trigeminal neuralgia. Clinical and angiographic presentations as well as their clinical outcomes after embolization were reviewed. RESULTS Of the 10 cases, seven dAVFs and three AVMs were detected. In contrast to the dilated feeding arteries, an ectasia of the draining vein that is adjacent to the root entry zone of the trigeminal nerve such as the petrosal vein and lateral mesencephalic vein has the major role in causing the trigeminal neuralgia. All of these patients had relief of facial pain after endovascular embolization during follow-up (mean 57.3 months, range 5 to 100 months). There were no permanent neurological deficits. CONCLUSIONS Endovascular embolization is an effective method in treating trigeminal neuralgia related to cerebral vascular malformation.
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Affiliation(s)
- Huijian Ge
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Beijing Engineering Research Center for Interventional Neuroradiology, Capital Medical University
| | - Xianli Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Beijing Engineering Research Center for Interventional Neuroradiology, Capital Medical University
| | - Hengwei Jin
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Beijing Engineering Research Center for Interventional Neuroradiology, Capital Medical University
| | - Hongwei He
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Beijing Engineering Research Center for Interventional Neuroradiology, Capital Medical University
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Beijing Engineering Research Center for Interventional Neuroradiology, Capital Medical University
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16
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Anichini G, Iqbal M, Rafiq NM, Ironside JW, Kamel M. Sacrificing the superior petrosal vein during microvascular decompression. Is it safe? Learning the hard way. Case report and review of literature. Surg Neurol Int 2016; 7:S415-20. [PMID: 27313970 PMCID: PMC4901823 DOI: 10.4103/2152-7806.183520] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 02/08/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Venous infarction as a complication of microvascular decompression (MVD) is a recognized but extremely rare occurrence in an otherwise standard neurosurgical procedure. Sacrificing one or more veins is considered safe by majority of experienced surgeons and authors. However, in the recent years, there has been growing debate about the management of venous trigeminal compression and/or superior petrosal complex (separation vs. coagulation and cutting of the vein), with few papers describing mild to severe complications related to venous sacrifice. CASE DESCRIPTION We report our dramatic experience during re-exploration for MVD on a male who developed massive cerebellar, brainstem, and brain infarction. Extensive analysis of surgical planning and literature debate about this topic is also reported. CONCLUSION Despite rare, venous infarction after venous sacrifice in MVD is possible and can have catastrophic consequences. We would advise: (1) To try preserving the vein anytime this is possible, especially if it is large in size; (2) if it is decided to sacrifice the vein temporary occlusion while observing changed in the neurophysiology might be safer; (3) when planning an MVD for suspected venous compression, possible alternative forms of treatment should also be considered.
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Affiliation(s)
- Giulio Anichini
- Department of Neurosurgery, Charing Cross Hospital, Imperial College of London, London
| | - Mazhar Iqbal
- Department of Neurosurgery, Aberdeen Royal Infirmary, NHS Grampian, Edinburgh, Scotland, UK
| | - Nasir Muhammad Rafiq
- Department of Neurosurgery, Aberdeen Royal Infirmary, NHS Grampian, Edinburgh, Scotland, UK
| | - James W. Ironside
- Department of Pathology, NHS Lothian, Western General Hospital, Edinburgh, Scotland, UK
| | - Mahmoud Kamel
- Department of Neurosurgery, Aberdeen Royal Infirmary, NHS Grampian, Edinburgh, Scotland, UK
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17
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Jito J, Nozaki K. Trigeminal Neuralgia Attributable to Intraneural Trigeminocerebellar Artery: Case Report and Review of the Literature. World Neurosurg 2016; 88:687.e7-687.e11. [PMID: 26714300 DOI: 10.1016/j.wneu.2015.11.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 11/12/2015] [Accepted: 11/14/2015] [Indexed: 11/24/2022]
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18
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Frossard JT, Domingues F, Neves P, Canhedo N, de Souza JM. Cavernous Malformation in the Trigeminal Distribution: A Case Report of Aggressive Presentation and Management. World Neurosurg 2015; 86:514.e19-22. [PMID: 26548819 DOI: 10.1016/j.wneu.2015.10.086] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 10/21/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cavernous malformation (CM) is a vascular malformation found in the encephalic parenchyma, spinal cord, nerve roots, and extraneural tissue. CM in the trigeminal distribution is exquisitely uncommon and its biological behavior not completely understood. The clinical picture might be diverse, depending on the affected sector of the trigeminal architecture, and literature debating its pathobiology is scarce. CASE DESCRIPTION We describe a case of 56-year-old woman who presented with left trigeminal neuralgia and a rapidly growing cavernous malformation of the entire distribution of the fifth nerve. The clinical picture evolved to a progressive gait ataxia and follow-up neuroimaging showed a large intracranial mass leading to a brainstem compression. After microsurgical resection, the mass proved to be a typical CM of the trigeminal root. CONCLUSION We present an uncommonly aggressive progression of a CM of the trigeminal root, Gasserian ganglion, and cavernous sinus evolving to severe brainstem compression. The documentation of this unique case as well as its management is presented is discussed.
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Affiliation(s)
- João Thiago Frossard
- Service of Neurosurgery and Post Graduation Program of Surgical Sciences, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Flavio Domingues
- Service of Neurosurgery and Post Graduation Program of Surgical Sciences, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Pedro Neves
- Department of Neuroradiology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nathalie Canhedo
- Department of Pathology and Post-Graduation Program of Pathology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jorge Marcondes de Souza
- Service of Neurosurgery and Post Graduation Program of Surgical Sciences, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
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Dual-Microcatheter Technique for a Dural Arteriovenous Fistula Manifesting as Trigeminal Neuralgia. Clin Neuroradiol 2015; 26:117-20. [DOI: 10.1007/s00062-015-0417-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 05/21/2015] [Indexed: 11/24/2022]
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20
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Li C, Li Y, Jiang C, Wu Z, Wang Y, Yang X. Remission of neurovascular conflicts in the cerebellopontine angle in interventional neuroradiology. J Neurointerv Surg 2014; 8:87-93. [DOI: 10.1136/neurintsurg-2014-011500] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 11/09/2014] [Indexed: 11/03/2022]
Abstract
Background and purposeTo investigate the efficacy of endovascular treatment (EVT) for neurovascular conflicts (NVCs) in the cerebellopontine angle (CPA) caused by intracranial aneurysms (IAs) and intracranial arteriovenous malformations (AVMs), including trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia.Materials and methodsFrom January 2010 to January 2014, 14 consecutive patients presenting with three NVCs caused by IAs or intracranial AVMs were admitted to our department. The clinical outcomes of these NVCs after EVT were retrospectively analyzed.ResultsFor four patients with IAs, angiographic follow-up confirmed total occlusion of the lesion in all, and the clinical outcomes of NVC were as follows: gradual relief in two (50%), transient partial relief but recurrence in one (25%), and no palliative effect in one (25%). For the 10 patients with intracranial AVMs, one (10%) experienced transient relief of NVC after angiogram examination (no EVT was performed). Of the other nine patients who received EVT, angiographic follow-up was obtained in seven (70%), demonstrating total obliteration of the lesion in three (30%), subtotal obliteration in two (20%), and partial obliteration in two (20%). Clinical outcomes included immediate relief of NVCs after single EVT in two cases (20%), gradual relief after single EVT in five (50%, one of them experienced transient aggravation), and complete relief after two sessions of EVT in two (20%). Complications of transient cranial nerve paresis related to EVT occurred in two cases (20%) with intracranial AVMs. In all, complete lasting relief of the NVCs was obtained finally in 11 cases (78.6%).ConclusionsEVT is a feasible and less invasive approach for relief of NVCs in the CPA caused by IA or intracranial AVM and could be considered as a therapeutic option in these situations.
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21
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Natural history, current concepts, classification, factors impacting endovascular therapy, and pathophysiology of cerebral and spinal dural arteriovenous fistulas. Clin Neurol Neurosurg 2014; 121:64-75. [DOI: 10.1016/j.clineuro.2014.01.018] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 01/12/2014] [Accepted: 01/19/2014] [Indexed: 11/24/2022]
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22
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Lu X, Qin X, Ni L, Chen J, Xu F. Tentorial dural arteriovenous fistula manifesting as contralateral trigeminal neuralgia: resolution after transarterial Onyx embolization. J Neurointerv Surg 2013; 6:e45. [DOI: 10.1136/neurintsurg-2013-010984.rep] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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23
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Lu X, Qin X, Ni L, Chen J, Xu F. Tentorial dural arteriovenous fistula manifesting as contralateral trigeminal neuralgia: resolution after transarterial Onyx embolization. BMJ Case Rep 2013; 2013:bcr-2013-010984. [PMID: 24285803 DOI: 10.1136/bcr-2013-010984] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Tentorial dural arteriovenous fistula (DAVF) as a cause of trigeminal neuralgia is extremely rare. Although less than 10 cases have been reported in the literature, all cases presented with ipsilateral trigeminal neuralgia. Here we report a unique case of tentorial DAVF manifesting as contralateral trigeminal neuralgia. A 58-year-old man presented with right-sided trigeminal neuralgia. Cerebral angiography revealed a left tentorial DAVF and the MR imaging demonstrated a variceal venous dilatation occupying the left lateral pontine cistern and multiple venous flow voids adjacent to the right trigeminal nerve root entry zone. Transarterial Onyx embolization resulted in near complete obliteration of the fistula with immediate resolution of facial pain. The patient remains symptom free and without evidence of recurrence during 9 months of follow-up. Transarterial Onyx embolization may be an effective treatment modality for such an usual case.
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Affiliation(s)
- Xiaojian Lu
- Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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24
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Harsha KJ, Kesavadas C, Chinchure S, Thomas B, Jagtap S. Imaging of vascular causes of trigeminal neuralgia. J Neuroradiol 2012. [DOI: 10.1016/j.neurad.2012.08.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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25
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Levitt MR, Ramanathan D, Vaidya SS, Hallam DK, Ghodke BV. Endovascular Palliation of AVM-Associated Intractable Trigeminal Neuralgia via Embolization of the Artery of the Foramen Rotundum. PAIN MEDICINE 2011; 12:1824-30. [DOI: 10.1111/j.1526-4637.2011.01277.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Furtado SV, Hegde AS. Trigeminal Neuralgia Due to a Small Meckel's Cave Epidermoid Tumor: Surgery Using an Extradural Corridor. Skull Base 2011; 19:353-7. [PMID: 20190946 DOI: 10.1055/s-0029-1220201] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Tumors at the petrous apex are associated with a variety of symptoms, which most often involve the trigeminal nerve. The authors present a rare case of a small epidermoid tumor in Meckel's cave that caused medically refractory trigeminal neuralgia. The surgical challenge associated with approaches to such lesions is discussed. The skull base tumor was excised completely through a small temporal craniotomy. The practicality of neuronavigation in reaching the petrous apex using a small extradural window is presented.
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Affiliation(s)
- Sunil V Furtado
- Department of Neurosurgery, Sri Satya Sai Institute of Higher Medical Sciences, Bangalore, India
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27
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Cenzato M, Stefini R, Ambrosi C, Latronico N, Milani D. Surgical Resolution of Trigeminal Neuralgia Due to Intra-Axial Compression by Pontine Cavernous Angioma. World Neurosurg 2010; 74:544-6. [DOI: 10.1016/j.wneu.2010.03.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 03/19/2010] [Indexed: 10/18/2022]
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28
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Akhaddar A, Gazzaz M, Elmostarchid B, Boucetta M. Trigeminal neuralgia and dural arteriovenous fistula in an edentulous man. Headache 2009; 50:861-2. [PMID: 19845783 DOI: 10.1111/j.1526-4610.2009.01555.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ali Akhaddar
- Department of Neurosurgery, Mohammed V Military Teaching Hospital, University of King Mohammed V-Souissi, Rabat, Morocco
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29
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Lesley WS. Resolution of Trigeminal Neuralgia Following Cerebellar AVM Embolization With Onyx. Cephalalgia 2009; 29:980-985. [DOI: 10.1111/j.1468-2982.2008.01828.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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.
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Affiliation(s)
- WS Lesley
- Texas A&M University Health Sciences Center, Scott & White Clinic, Departments of Radiology Surgery, Temple, TX, USA
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30
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Lv X, Jiang C, Zhang J, Li Y, Wu Z. Complications related to percutaneous transarterial embolization of intracranial dural arteriovenous fistulas in 40 patients. AJNR Am J Neuroradiol 2009; 30:462-8. [PMID: 19131416 PMCID: PMC7051438 DOI: 10.3174/ajnr.a1419] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE An increasing number of intracranial dural arteriovenous fistulas (DAVFs) are amenable to endovascular treatment with Onyx. However, reports on complications caused by this technique have been limited. We present the initial Beijing Tiantan Hospital experience with adverse events related to transarterial Onyx embolization for DAVFs. MATERIALS AND METHODS Between September 2005 and February 2008, a total of 40 patients with DAVFs were treated at our institute with Onyx-18. There were 11 women and 29 men with a mean age of 43.15 years (age range, 23-60 years). We reviewed the clinical presentation, angiographic features, treatment, and outcome. RESULTS In 40 patients, total obliteration was achieved in 25 DAVFs (62.5%), with the remaining 15 patients not cured with residual shunts. Complications occurred in 9 patients, 5 DAVFs were located at tentorium, 2 were located at the transverse-sigmoid sinus, 1 was found at the inferior petrosal sinus, and 1 was found at the cavernous sinus, leading to permanent disability in 3 patients (morbidity, 7.5%). Complications included reflexive bradyarrhythmia in 3 (7.5%) patients, hemifacial hypoesthesia in 3 (7.5%) patients, hemifacial palsy in 2 (5%) patients, posterior fossa infarction in 2 (5%) patients, jaw pain in 1 (2.5%) patient, microcatheter gluing in 1 (2.5%) patient, hallucinations in 1 (2.5%) patient, and Onyx migration in 1 (2.5%) patient. CONCLUSION Although complete cure can be achieved by transarterial embolization with Onyx, the potential for serious complications exists with this procedure.
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Affiliation(s)
- X Lv
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
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31
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Lv X, Jiang C, Li Y, Wu Z. Results and complications of transarterial embolization of intracranial dural arteriovenous fistulas using Onyx-18. J Neurosurg 2008; 109:1083-90. [PMID: 19035723 DOI: 10.3171/jns.2008.109.12.1083] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECT Use of the Onyx liquid embolic system has become an option for treating dural arteriovenous fistulas (DAVFs) because of its advantageous nonadhesive and cohesive properties. However, the complication rates associated with the use of this system have not been reported. The authors present their initial experience of the risks related to transarterial embolization using this system. METHODS Between February 2005 and February 2007, 31 patients with DAVFs were treated at Beijing Tiantan Hospital. Transarterial embolization using Onyx-18 was performed as a preoperative adjunct or as definitive therapy. The demographic characteristics, angiographic features, clinical presentation, treatment, and outcome of the patients were reviewed. Clinical follow-up status was supplemented by telephone interviews to determine Glasgow Outcome Scale scores. RESULTS In 19 patients (61.3%) there was complete angiographic evidence of elimination of the shunts and resolution of the symptoms. The remaining 12 patients were treated successfully but did not attain complete embolization and had residual shunting. Adverse events occurred in 5 of 31 patients, with 3 DAVFs located at the tentorium, 1 at the inferior petrosal sinus, and 1 at the cavernous sinus. Complications included trigeminocardiac reflex in 2 patients (6.5%), hemifacial hypesthesia in 3 patients (9.7%), hemifacial palsy in 2 patients (6.5%), jaw pain in 1 patient (3.2%), posterior fossa infarction in 1 patient (3.2%), and microcatheter gluing in 1 patient (3.2%). At the last follow-up examination, all patients had returned to an independent clinical status. CONCLUSIONS Although a complete resolution of symptoms can be achieved with transarterial embolization using the Onyx liquid embolic system, the potential for serious complications exists with this procedure, necessitating the participation of a skilled neurointerventionalist.
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Affiliation(s)
- Xianli Lv
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
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32
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Dural arteriovenous fistula of the transverse-sigmoid sinus causing trigeminal neuralgia. Acta Neurochir (Wien) 2007; 149:1249-53; discussion 1253. [PMID: 17965821 DOI: 10.1007/s00701-007-1367-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Accepted: 09/11/2007] [Indexed: 10/22/2022]
Abstract
The authors analysed an unusual case of dural arteriovenous fistula (DAVF) of the transverse-sigmoid sinus causing trigeminal neuralgia is presented. Although progression to almost continuous facial pain has been reported, symptoms may be indistinguishable from typical trigeminal neuralgia. The patient had a 6-year history of right-sided trigeminal neuralgia initially well controlled by medical management. He was referred for surgical management after 10 months of progressively worsening of symptoms. At the time of consultation, the patient complained of pulsatile tinnitus in the right ear. Computed tomography imaging and angiography demonstrated a DAVF involving the right transverse-sigmoid sinus junction with retrograde venous drainage. Surgical resection of the DAVF provided both angiographic cure and complete relief of all symptoms. The authors discuss the pathophysiology of trigeminal neuralgia in patients with a DAVF.
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Rahme R, Ali Y, Slaba S, Samaha E. Dural arteriovenous malformation: an unusual cause of trigeminal neuralgia. Acta Neurochir (Wien) 2007; 149:937-41; discussion 941. [PMID: 17676410 DOI: 10.1007/s00701-007-1251-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Accepted: 07/02/2007] [Indexed: 01/24/2023]
Abstract
Trigeminal neuralgia has been rarely reported in association with dural arteriovenous malformations (DAVMs). We describe a case of trigeminal neuralgia resulting from compression of the trigeminal nerve at its root entry zone by a large tentorial DAVM. Surgical interruption of the draining vein at its exit from the tentorium resulted in complete angiographic obliteration of the fistula with immediate resolution of the facial pain. We review the literature relevant to this topic and discuss the aetiology and pathophysiology of trigeminal neuralgia as well as the management of tentorial DAVMs.
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Affiliation(s)
- R Rahme
- Department of Neurosurgery, Saint-Joseph University Faculty of Medicine and Hôtel-Dieu de France, Beirut, Lebanon
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Lucas CDP, Caldas JGMP, Prandini MN. Do leptomeningeal venous drainage and dysplastic venous dilation predict hemorrhage in dural arteriovenous fistula? ACTA ACUST UNITED AC 2007; 66 Suppl 3:S2-5; discussion S5-6. [PMID: 17081847 DOI: 10.1016/j.surneu.2006.02.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2005] [Accepted: 02/09/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND The objective of this study was to correlate the presence of leptomeningeal venous drainage and dysplastic venous dilation with the risk of intracranial hemorrhage in DAVFs. METHODS The subjects for this research were composed of 93 patients with DAVFs who were studied retrospectively with regard to therapeutic success and failure, who had undergone either neurosurgery or embolization or a combination of both methods, and whose disease was located in the cavernous sinus, the superior sagittal sinus, or the transverse-sigmoid sinus of the anterior fossa or of the tentorium. Also among these study subjects were patients who had had angiography done in at least 6 cranial vessels (external and internal carotid and vertebral arteries) before and after treatment and who had a minimum follow-up of 3 months. Cases of leptomeningeal venous drainage and dysplastic venous dilation and their associations with intracranial hemorrhage were ascertained for all the 93 case patients included in the study. RESULTS The presence of leptomeningeal drainage (P = .0002) and that of dysplastic venous dilation (P = .036) increased the risk of intracranial hemorrhage in case patients for DAVFs of the 5 regions. CONCLUSION There is a statistical significance between risk of intracranial hemorrhage in DAVFs and the presence of leptomeningeal drainage and dysplastic venous dilation.
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Affiliation(s)
- César de Paula Lucas
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
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35
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Kraemer JL, Pereira Filho ADA, David GD, Faria MDB. Vertebrobasilar dolichoectasia as a cause of trigeminal neuralgia: the role of microvascular decompression. Case report. ARQUIVOS DE NEURO-PSIQUIATRIA 2006; 64:128-31. [PMID: 16622569 DOI: 10.1590/s0004-282x2006000100027] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Our purpose is to report a case of trigeminal neuralgia caused by vertebrobasilar dolichoectasia treated with microvascular decompression. A 63-year-old man sought treatment for a recurrent lancinating left facial pain in V2 and V3 trigeminal territories. The computed tomography angiography revealed a mechanical compression of the left trigeminal nerve due to vertebrobasilar dolichoectasia. The patient was submitted to a left suboccipital craniotomy. Shredded Teflon® was introduced in the conflicting neurovascular area, achieving a satisfactory decompression. The patient’s pain resolved immediately. Vertebrobasilar dolichoectasia is a rare cause of trigeminal neuralgia and a successful outcome can be achieved with microvascular decompression.
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Affiliation(s)
- Jorge Luiz Kraemer
- Hospital São José, Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil.
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36
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Abstract
This study describes the seemingly rare occurrence of bone formation within the proximal superior aspect of Meckel's cave thus forming a bony foramen for the proximal trigeminal nerve to traverse. The anatomy of Meckel's cave is reviewed and the clinical potential for nerve compression from this bony anomaly discussed.
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Affiliation(s)
- R Shane Tubbs
- Department of Cell Biology, University of Alabama at Birmingham, 35233, USA.
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Deshmukh VR, Hott JS, Tabrizi P, Nakaji P, Feiz-Erfan I, Spetzler RF. Cavernous Malformation of the Trigeminal Nerve Manifesting with Trigeminal Neuralgia: Case Report. Neurosurgery 2005; 56:E623. [DOI: 10.1227/01.neu.0000154063.05728.7e] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2004] [Accepted: 12/13/2004] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE AND IMPORTANCE:
We describe a patient with a cavernous malformation within the trigeminal nerve at the nerve root entry zone who presented with trigeminal neuralgia.
CLINICAL PRESENTATION:
A 52-year-old woman sought treatment after experiencing dizziness and lancinating left facial pain for almost a year. Neurological examination revealed diminished sensation in the distribution of the trigeminal nerve on the left. Magnetic resonance imaging demonstrated a minimally enhancing lesion affecting the trigeminal nerve.
INTERVENTION:
The patient underwent a retrosigmoid craniotomy. At the nerve root entry zone, the trigeminal nerve was edematous with hemosiderin staining. The lesion, which was resected with microsurgical technique, had the appearance of a cavernous malformation on gross and histological examination. The patient's pain improved significantly after resection.
CONCLUSION:
Cavernous malformations can afflict the trigeminal nerve and cause trigeminal neuralgia. Microsurgical excision can be performed safely and is associated with improvement in symptoms.
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Affiliation(s)
- Vivek R. Deshmukh
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Jonathan S. Hott
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Peyman Tabrizi
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Peter Nakaji
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Iman Feiz-Erfan
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Robert F. Spetzler
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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