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Düzkalir AH, Askeroglu MO, Peker S. Stereotactic radiosurgery for arteriovenous malformations presenting as secondary trigeminal neuralgia: a case series. Neurosurg Rev 2025; 48:245. [PMID: 39960652 PMCID: PMC11832636 DOI: 10.1007/s10143-025-03400-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2024] [Revised: 01/09/2025] [Accepted: 02/09/2025] [Indexed: 02/20/2025]
Abstract
Stereotactic radiosurgery (SRS) is a potential treatment for trigeminal neuralgia (TN) secondary to arteriovenous malformations (AVMs), though its efficacy and safety remain unclear due to the rarity of this condition. We analyzed 1211 brain AVM cases treated with Gamma Knife radiosurgery (GKRS) between 2005 and 2023 at our institution. Four patients (0.33%) were presented with TN secondary to AVM. Three patients received single-fraction GKRS while one underwent hypofractionated treatment. Treatment outcomes were assessed using magnetic resonance imaging, digital subtraction angiography, and the Barrow Neurological Institute pain intensity scale. The mean marginal dose and AVM volume were 21.5 Gy and 0.58 cc, respectively. The mean follow-up period was 85.75 months. Complete AVM obliteration was achieved in all patients, with all experiencing complete pain relief within a mean time of 18 months, enabling gradual discontinuation of medications. No radiation-related adverse effects were observed. Our literature review identified only 15 previously reported cases where SRS was used as primary treatment for TN secondary to AVM, with most cases showing favorable outcomes in pain relief and AVM obliteration. This study is the first case series to demonstrate the sole use and efficacy of GKRS in managing TN secondary to AVM, moving beyond individual case reports. SRS appears to be a safe and effective primary treatment option for TN secondary to AVM, particularly when conventional surgical approaches are contraindicated or pose excessive risks. The sustained pain relief and absence of complications in our series, combined with previous case reports, support its use in managing this rare condition.
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Affiliation(s)
- Ali Haluk Düzkalir
- Department of Neurosurgery, Koç University Hospital, Istanbul, Turkey
- Department of Neurosurgery, Gamma Knife Center, Koç University Hospital, Istanbul, Turkey
| | - Mehmet Orbay Askeroglu
- Department of Neurosurgery, Gamma Knife Center, Koç University Hospital, Istanbul, Turkey
| | - Selcuk Peker
- Department of Neurosurgery, Gamma Knife Center, Koç University Hospital, Istanbul, Turkey.
- Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey.
- Koç University Hospital, Davutpasa St., No: 4, Topkapi, Istanbul, 34010, Turkey.
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Severo Bem Junior L, Fechine de Alencar Neto J, Augusto Lustosa Nogueira J, Sena Almeida N, Rocha Cirne de Azevedo Filho H. Trigeminal neuralgia secondary to arteriovenous malformation in the brainstem: a case report and a brief review. HEADACHE MEDICINE 2022. [DOI: 10.48208/headachemed.2021.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Trigeminal neuralgia, a condition characterized by high intensity, paroxysmal and unilateral pain, can be characterized as secondary when associated with conditions such as multiple sclerosis and tumors. However, among these secondary cases, there are also arteriovenous malformations, characterized by a nidus mass of vessels separated by parts of sclerotic tissues, responsible for a small portion of the neuralgias of the trigeminal nerve. The case report described is of a 54-year-old male patient who has a brainstem AVM and refers to lancing and paroxysmal pain in the right hemiface in the territories of V2 and V3 after feeding and brushing the teeth. The treatment of this patient was done from the insertion of a balloon from the foramen ovale, accessed by the Meckel fossa and the trigeminal ganglion. The literature review demonstrated, from the analysis of gender, age, vascularization, localization and treatments of reports of TGN secondary to brainstem AVM, the reduced number of cases described.
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Nagai A, Endo H, Sato K, Kawaguchi T, Uchida H, Omodaka S, Matsumoto Y, Tominaga T. Arteriovenous malformation of the trigeminal nerve root presented with venous congestive edema of the medulla oblongata and upper cervical cord: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21402. [PMID: 35854946 PMCID: PMC9265207 DOI: 10.3171/case21402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/26/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Arteriovenous malformation (AVM) of the trigeminal nerve root (TNR) is a rare subtype of the lateral pontine AVM. Most of them are diagnosed when they bleed or exert trigeminal neuralgia. Venous congestive edema is a rare phenomenon caused by TNR AVMs. OBSERVATIONS An 82-year-old man was admitted with progressive limb weakness and dysphasia. Magnetic resonance imaging (MRI) revealed extensive edema of the medulla oblongata and the upper cervical cord with signal flow void at the C3 anterior spinal cord. Vertebral angiography revealed a small nidus fed mainly by the pontine perforating arteries (PPAs). The anterior pontomesencephalic vein (AMPV) was dilated, functioning as the main drainage route. This suggests that venous hypertension triggered the brainstem and upper cervical cord edema. MRI with gadolinium enhancement showed that the nidus was located around the right TNR. Because the nidus sat extrinsically on the pial surface of the right TNR’s base, microsurgical obliteration with minimum parenchymal injury was achieved. Postoperative MRI showed disappearance of the brainstem and cervical cord edema with improved clinical symptoms. LESSONS TNR AVM is rarely associated with brainstem and upper cervical cord edema caused by venous hypertension of the congestive drainage system.
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Affiliation(s)
- Arata Nagai
- Department of Neurosurgery, Kohnan Hospital, Sendai, Japan
| | - Hidenori Endo
- Department of Neurosurgery, Kohnan Hospital, Sendai, Japan
- Division of Advanced Cerebrovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kenichi Sato
- Department of Neurosurgery, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Japan
| | | | - Hiroki Uchida
- Department of Neurosurgery, Kohnan Hospital, Sendai, Japan
| | - Shunsuke Omodaka
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan; and
| | - Yasushi Matsumoto
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan; and
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Das KK, Gosal JS, Ashish K, Gandhi A, Jaiswal AK, Behari S. Trigeminal Neuralgia from an Arteriovenous Malformation of the Trigeminal Root Entry Zone with a Flow-Related Feeding Artery Aneurysm: The Role of a Combined Endovascular and "Tailored" Surgical Treatment. Neurol India 2021; 69:744-747. [PMID: 34169881 DOI: 10.4103/0028-3886.319235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Idiopathic trigeminal neuralgia (TN) due to an embedded arteriovenous malformation (AVM) on the trigeminal root entry zone (REZ) is rare but a potentially challenging condition to manage. Herein, we report such a case with an additional unruptured aneurysm on the feeding artery and highlight the role of a multimodality approach to their management. A 50-year-old female presented with drug-resistant right-sided trigeminal neuralgia for one year. The magnetic resonance imaging (MRI) suggested a possibility of AVM, the angiographic study showed an AVM nidus with feeders from the right anterior inferior cerebellar artery (AICA) and a dilated right intrinsic pontine artery, the latter showing a flow-related aneurysm towards its brainstem end. The flow-related aneurysm, as well as the dilated intrinsic pontine artery feeder, was embolized at first. During surgery, the AVM was found embedded inside the root entry zone. Parts of the AVM and its draining vein were partially coagulated followed by microvascular decompression of the AICA loop as well as a feeder emanating from it following which the patient recovered completely. She subsequently received gamma knife surgery (GKS) for the residual AVM and remained asymptomatic after 3.5 years of GKS. AVM-related TN are rare, and the additional presence of a feeding artery aneurysm increases the management complexity. Endovascular management of the aneurysm followed by microvascular decompression (MVD) and tailored AVM coagulation represent a prompt and effective means of pain control. Subsequent GKS is necessary to obliterate the AVM nidus.
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Affiliation(s)
- Kuntal K Das
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, Uttar Pradesh, India
| | - Jaskaran S Gosal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, Uttar Pradesh, India
| | - Kumar Ashish
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, Uttar Pradesh, India
| | - Anish Gandhi
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, Uttar Pradesh, India
| | - Awadhesh K Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, Uttar Pradesh, India
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Endo H, Osawa SI, Matsumoto Y, Endo T, Sato K, Niizuma K, Fujimura M, Tominaga T. Embolization of ruptured arteriovenous malformations in the cerebellopontine angle cistern. Neurosurg Rev 2017; 41:173-182. [PMID: 28220368 DOI: 10.1007/s10143-017-0832-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/07/2017] [Accepted: 02/08/2017] [Indexed: 11/29/2022]
Abstract
Among brainstem arteriovenous malformations (AVMs), there exist small AVMs predominantly located in the cerebellopontine angle cistern (CPAC) with minimal extension into the pial surface of the brainstem. However, previous studies of CPAC AVMs did not particularly discuss the role of embolization in the treatment of these lesions. This study was conducted to clarify the effectiveness and validity of embolization in the treatment of CPAC AVMs. We retrospectively reviewed five patients with CPAC AVMs who underwent endovascular treatment. These patients were treated with embolization followed by open surgery or gamma knife (GK) radiosurgery. Radiological findings and clinical course for these patients were then assessed. All five patients presented with a hemorrhage. Angiography revealed that the main feeder contained a dilated pontine perforating artery in all cases. Embolization through the dilated pontine perforating artery effectively reduced shunt flow within the nidus or obliterated associated aneurysms. Magnetic resonance imaging showed infarction on the lateral pons in four patients, one of which developed transient mild dizziness and mild ataxia of the right side. Subsequent open surgery was performed in three patients, and GK radiosurgery was performed in two patients without complications. At the end of the follow-up period, all patients demonstrated favorable outcomes. Postoperative rebleeding did not occur in any of the patients. Disappearance of the AVM was confirmed in four patients, except in the one patient treated with GK. Although ischemic complications should be noted, embolization of CPAC AVMs may be an appropriate treatment option to reduce the risk of subsequent surgery or radiosurgery.
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Affiliation(s)
- Hidenori Endo
- Departments of Neurosurgery, Kohnan Hospital, 4-20-1 Nagamachi-minami, Taihaku-ku, Sendai, 982-8523, Japan.
| | - Shin-Ichiro Osawa
- Departments of Neurosurgery, Kohnan Hospital, 4-20-1 Nagamachi-minami, Taihaku-ku, Sendai, 982-8523, Japan
| | - Yasushi Matsumoto
- Departments of Neuroendovascular therapy, Kohnan Hospital, Sendai, Miyagi, Japan
| | - Toshiki Endo
- Departments of Neurosurgery, Kohnan Hospital, 4-20-1 Nagamachi-minami, Taihaku-ku, Sendai, 982-8523, Japan
| | - Kenichi Sato
- Departments of Neuroendovascular therapy, Kohnan Hospital, Sendai, Miyagi, Japan
| | - Kuniyasu Niizuma
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Miki Fujimura
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Trigeminal Neuralgia Caused by Cerebellopontine Angle Arteriovenous Malformation Treated With Gamma Knife Radiosurgery. J Craniofac Surg 2016; 27:e55-7. [PMID: 26674920 DOI: 10.1097/scs.0000000000002310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Trigeminal neuralgia is a facial pain syndrome characterized as sudden onset and lightening-like sensation over somatosensorial branch(es) of fifth cranial nerve. Rarely, some underlying diseases or disorders could be diagnosed, such as multiple sclerosis, brain tumors, and vascular malformations. The authors present a 47-year-old man with trigeminal neuralgia over left V2 and V3 dermatomes. He had a previous transarterial embolization and long use of carbamazepine with partial response to treatment. Gamma knife radiosurgery (GKR) was planned. A marginal dose of 15 Gy was given to 50% isodose line. His pain was relieved by GKR in 1.5 years. Treatment of posterior fossa arteriovenous malformations causing trigeminal neuralgia, with GKR has a very limited use in the literature. It, however, is obvious that success rate as pain relief, in a very challenging field of functional neurosurgery, is satisfactory. Large series, however, are in need to make a more comprehensive statement about efficacy and safety of the procedure in these pathologies.
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YUAN YONGJIE, ZHANG YANDONG, LUO QI, YU JINLU. Trigeminal neuralgia caused by brain arteriovenous malformations: A case report and literature review. Exp Ther Med 2016; 12:69-80. [PMID: 27347019 PMCID: PMC4906999 DOI: 10.3892/etm.2016.3277] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 03/01/2016] [Indexed: 01/03/2023] Open
Abstract
Few cases of trigeminal neuralgia (TGN) induced by brain arteriovenous malformations (bAVMs) have previously been reported. The present case report described one case of TGN caused by bAVMs in a 32-year-old male patient who suffered from recurrent pain in his right cheek for a period of two years, for whom the seizure frequency and duration of pain increased for 6 months. Magnetic resonance imaging was performed, which demonstrated flow-void signals in the abnormal vessels in the right cerebellopontine angle. Subsequent digital subtraction angiography confirmed the diagnosis of bAVMs, and showed the nidus was fed by the right superior cerebellar and the right anterior inferior cerebellar, and drained into the adjacent venous sinuses on the same side. The patient underwent an interventional embolization treatment. TGN was completely relieved following embolization of the majority of the bAVMs. Pain relief may be associated with blocking of the pulsatile compression of the feeding arteries of the bAVMs, the arterialized draining veins or the malformed niduses following embolization, which is similar to the effects induced by microvascular decompression surgery of the trigeminal nerve. In the present case study and review, the underlying mechanism and treatment strategy of TGN caused by bAVMs were discussed in the context of present case, and a literature review was carried out.
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Affiliation(s)
- YONGJIE YUAN
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - YANDONG ZHANG
- Department of Medicine, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - QI LUO
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - JINLU YU
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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Nishino K, Hasegawa H, Morita K, Fukuda M, Ito Y, Fujii Y, Sato M. Clinical characteristics of arteriovenous malformations in the cerebellopontine angle cistern. J Neurosurg 2016; 126:60-68. [PMID: 27035170 DOI: 10.3171/2015.12.jns152190] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Arteriovenous malformations (AVMs) in the cerebellopontine angle cistern (CPAC) are specific lesions that can cause neurovascular compression syndromes as well as intracranial hemorrhage. Although case reports describing the CPAC AVMs, especially those presenting with trigeminal neuralgia (TN), have been accumulating by degrees, the pathophysiology of CPAC AVMs remains obscure. The authors' purpose in the present study was to evaluate the clinical and radiographic features of CPAC AVMs as well as the treatment options. METHODS This study defined a CPAC AVM as a small AVM predominantly located in the CPAC with minimal extension into the pial surface of the brainstem and closely associated with cranial nerves. All patients with CPAC AVMs treated in the authors' affiliated hospitals over a 16-year period were retrospectively identified. Clinical charts, imaging studies, and treatment options were evaluated. RESULTS Ten patients (6 men and 4 women), ranging in age from 56 to 77 years (mean 65.6 years), were diagnosed with CPAC AVMs according to the authors' definition. Six patients presented with hemorrhage, 3 with TN, and the remaining patient developed a hemorrhage subsequent to TN. Seven AVMs were associated with the trigeminal nerve (Group V), and 3 with the facial-vestibulocochlear nerve complex (Group VII-VIII). All patients in Group VII-VIII presented with the hemorrhage instead of hemifacial spasm. Regarding angioarchitecture, the intrinsic pontine arteries provided the blood supply for all CPAC AVMs in Group V. In addition, 5 of 7 AVMs with hemorrhagic episodes accompanied flow-related aneurysms, although no aneurysm was detected in patients with TN alone. With respect to treatment, all patients with hemorrhagic presentation underwent Gamma Knife surgery (GKS), resulting in favorable outcomes except for 1 patient who experienced rebleeding after GKS, which was caused by the repeated rupture of a feeder aneurysm. The AVMs causing TN were managed with surgery, GKS, or a combination, according to the nidus-nerve relationship. All patients eventually obtained pain relief. CONCLUSIONS Clinical symptoms caused by CPAC AVMs occur at an older age compared with AVMs in other locations; CPAC AVMs also have distinctive angioarchitectures according to their location in the CPAC. Although GKS is likely to be an effective treatment option for the CPAC AVMs with hemorrhagic presentations, it seems ideal to obliterate the flow-related aneurysms before performing GKS, although this is frequently challenging. For CPAC AVMs with TN, it is important to evaluate the nidus-nerve relationship before treatment, and GKS is especially useful for patients who do not require urgent pain relief.
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Affiliation(s)
- Kazuhiko Nishino
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata; and
| | - Hitoshi Hasegawa
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata; and
| | - Kenichi Morita
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata; and
| | - Masafumi Fukuda
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata; and
| | - Yasushi Ito
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata; and
| | - Yukihiko Fujii
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata; and
| | - Mitsuya Sato
- Gamma Knife Center, Kitanihon Neurosurgical Hospital, Gosen, Japan
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Robert T, Blanc R, Ciccio G, Smajda S, Redjem H, Fahed R, Piotin M. Trigeminal neuralgia due to arterialization of the superior petrosal vein in the context of dural or cerebral arteriovenous shunt. Clin Neurol Neurosurg 2015; 138:83-8. [DOI: 10.1016/j.clineuro.2015.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 07/27/2015] [Accepted: 08/06/2015] [Indexed: 10/23/2022]
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Tucker A, Tsuji M, Yamada Y, Hanabusa K, Ukita T, Miyake H, Ohmura T. Arteriovenous malformation of the vestibulocochlear nerve. World J Clin Cases 2015; 3:661-670. [PMID: 26244159 PMCID: PMC4517342 DOI: 10.12998/wjcc.v3.i7.661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 11/14/2014] [Accepted: 04/20/2015] [Indexed: 02/05/2023] Open
Abstract
We describe a rare case of an arteriovenous malformation (AVM) embedded in the vestibulocochlear nerve presenting with subarachnoid hemorrhage (SAH) treated by microsurgical elimination of the main feeding artery and partial nidus volume reduction with no permanent deficits. This 70-year-old woman was incidentally diagnosed 4 years previously with two small unruptured tandem aneurysms (ANs) on the right anterior inferior cerebral artery feeding a small right cerebellopontine angle AVM. The patient was followed conservatively until she developed sudden headache, nausea and vomiting and presented to our outpatient clinic after several days. Magnetic resonance imaging demonstrated findings suggestive of early subacute SAH in the quadrigeminal cistern. A microsurgical flow reduction technique via clipping between the two ANs and partial electrocoagulation of the nidus buried within the eighth cranial nerve provided radiographical devascularization of the ANs with residual AVM shunt flow and no major deficits during the 2.5 year follow-up. This is only the second report of an auditory nerve AVM. In the event of recurrence, reoperation or application of alternative therapies may be considered.
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Persistent trigeminal artery supply to an intrinsic trigeminal nerve arteriovenous malformation: A rare cause of trigeminal neuralgia. J Clin Neurosci 2015; 22:409-12. [DOI: 10.1016/j.jocn.2014.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 06/12/2014] [Indexed: 11/24/2022]
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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: 0.6] [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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Duransoy YK, Mete M, Akçay E, Selçuki M. Differences in individual susceptibility affect the development of trigeminal neuralgia. Neural Regen Res 2014; 8:1337-42. [PMID: 25206428 PMCID: PMC4107645 DOI: 10.3969/j.issn.1673-5374.2013.14.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 03/07/2013] [Indexed: 11/18/2022] Open
Abstract
Trigeminal neuralgia is a syndrome due to dysfunctional hyperactivity of the trigeminal nerve, and is characterized by a sudden, usually unilateral, recurrent lancinating pain arising from one or more divisions of the nerve. The most accepted pathogenetic mechanism for trigeminal neuralgia is compression of the nerve at its dorsal root entry zone or in its distal course. In this paper, we report four cases with trigeminal neuralgia due to an unknown mechanism after an intracranial intervention. The onset of trigeminal neuralgia after surgical interventions that are unrelated to the trigeminal nerve suggests that in patients with greater individual susceptibility, nerve contact with the vascular structure due to postoperative pressure and changes in cerebrospinal fluid flow may cause the onset of pain.
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Affiliation(s)
| | - Mesut Mete
- Department of Neurosurgery, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Emrah Akçay
- Clinic of Neurosurgery, Anamur State Hospital, Mersin, Turkey
| | - Mehmet Selçuki
- Department of Neurosurgery, Celal Bayar University School of Medicine, Manisa, Turkey
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14
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A Successful Treatment of Coexistent Hemifacial Spasm and Trigeminal Neuralgia Caused by a Huge Cerebral Arteriovenous Malformation. J Craniofac Surg 2014; 25:907-10. [DOI: 10.1097/scs.0000000000000567] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Mori Y, Kobayashi T, Miyachi S, Hashizume C, Tsugawa T, Shibamoto Y. Trigeminal neuralgia caused by nerve compression by dilated superior cerebellar artery associated with cerebellar arteriovenous malformation: case report. Neurol Med Chir (Tokyo) 2013; 54:236-41. [PMID: 24257486 PMCID: PMC4533427 DOI: 10.2176/nmc.cr2012-0370] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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.
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