RadiosurgeryTentorial dural arteriovenous malformation manifesting as trigeminal neuralgia treated by stereotactic radiosurgery: a case report
Introduction
Tentorial dAVMs as a cause of trigeminal neuralgia are extremely rare. Only 7 cases have been reported in the available literature [3], [9], [10], [11], [16], [17], [19], [24]. Treatment strategy of tentorial dAVMs is still debated because of the rich variety of their flow types and the surgical difficulty for such deeply seated lesions. Most tentorial dAVMs are classified into Borden type II or III, which are usually related to a high risk of hemorrhagic phenomena [1], [3], [6]. The tentorial arteriovenous malformations (AVMs) associated with sinus thrombosis, retrograde leptomeningeal venous drainage, and venous varix have a much higher probability of hemorrhage [1], [4]. We report the case of a patient with a tentorial dural AVM manifesting as trigeminal neuralgia, associated with leptomeningeal venous return and venous aneurysm. We also discuss the feasibility of SRS as one of the treatment modalities for tentorial dAVMs.
Section snippets
Case report
A 50-year-old man presented with a 1-month history of facial pain in the second and third divisions of the right trigeminal nerve. The patient consulted us for further evaluation and treatment. Neurologic examination revealed hypesthesia and lancinating pain in the second and third division of the right trigeminal nerve. Magnetic resonance imaging revealed that the right petrosal vein with venous varix was causing compression at the root entry zone of the right trigeminal nerve (Fig. 1A).
Discussion
Tentorial dAVMs are relatively rare, accounting for only 8.4% of 377 dAVMs reviewed in a retrospective meta-analysis of the literature and clinical experience [1]. Most of them manifest hemorrhagic stroke; tentorial AVMs as a cause of trigeminal neuralgia are extremely uncommon. This has rarely been reported, and only 7 cases are described in the available literature [3], [9], [10], [11], [16], [17], [19], [24]. In summary, according to precise records, including those of our case, 3 males and
Conclusions
The authors report an unusual case of dAVM manifesting as trigeminal neuralgia. The patient was treated by SRS, resulting in complete resolution of the trigeminal neuralgia. Stereotactic radiosurgery may be effective for tentorial AVMs within the limitations of smaller-sized AVMs or low-flow shunts.
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2022, Progress in Brain ResearchCitation Excerpt :In the first there was a petrotentorial fistula with a vein compressing the adjacent trigeminal nerve. The prescription dose was 18 Gy (Matsushige et al., 2006) and the patient became pain free. The other case was a right sided DAVF surrounding the right trigeminal nerve.
Trigeminal Neuralgia Caused by Dural Arteriovenous Fistula in Meckel Cave Treated with Gamma Knife Radiosurgery
2019, World NeurosurgeryCitation Excerpt :However, it is unclear if these findings can be extrapolated to TGN caused by DAVF. Options for treatment for typical DAVF include observation,13 embolization,11,14,15 stereotactic surgery,3,16 surgical obliteration,17 or combinations of the aforementioned techniques.10,18 Although complete surgical resection is an ideal option for patients with a history of hemorrhage, complete surgical resection may be limited because of the risks associated with certain locations of the fistula.6,19