Tentorial dural arteriovenous malformation manifesting as trigeminal neuralgia treated by stereotactic radiosurgery: A case report

Surg Neurol. 2006 Nov;66(5):519-23; discussion 523. doi: 10.1016/j.surneu.2006.01.022. Epub 2006 Jul 21.

Abstract

Background: Tentorial dAVMs as a cause of trigeminal neuralgia are extremely rare. Consensus exists that radical treatment of such high-flow dAVMs should be considered because of their high risk of bleeding. The authors present a case of a 50-year-old man who presented with symptoms of tic douloureux caused by tentorial dAVM, which was treated successfully by SRS.

Case description: The patient consulted us with a 1-month history of harboring right trigeminal neuralgia. The cerebral angiography revealed a dAVM in the petrotentorial region and the MRI demonstrated a dilated petrosal venous varix compressing the root entry zone of the right trigeminal nerve. Gamma knife surgery was performed with a marginal dose of 18 Gy and a maximum dose of 30 Gy in a volume of 0.3 mL. The target point of the radiosurgery for this patient was a fistula identified by superselective angiography, enhanced computed tomography, and MRI. Follow-up MRI, 1 year after GKS, showed a thrombosed lesion, and the patient was able to end medication. There was no evidence of recurrence or adverse effects in the 3-year follow-up.

Conclusion: Stereotactic radiosurgery can play an effective role as a treatment modality for such unusual dAVMs.

Publication types

  • Case Reports

MeSH terms

  • Central Nervous System Vascular Malformations / complications*
  • Central Nervous System Vascular Malformations / diagnosis
  • Central Nervous System Vascular Malformations / surgery*
  • Cerebral Angiography
  • Cerebral Arteries / abnormalities
  • Cerebral Arteries / diagnostic imaging
  • Cerebral Arteries / pathology
  • Cerebral Veins / abnormalities
  • Cerebral Veins / diagnostic imaging
  • Cerebral Veins / pathology
  • Cerebrovascular Circulation / physiology
  • Cranial Fossa, Posterior / anatomy & histology
  • Cranial Fossa, Posterior / pathology
  • Cranial Fossa, Posterior / surgery
  • Cranial Sinuses / abnormalities
  • Cranial Sinuses / diagnostic imaging
  • Cranial Sinuses / pathology
  • Dura Mater / blood supply
  • Dura Mater / physiopathology
  • Dura Mater / surgery
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Preoperative Care / standards
  • Radiation Dosage
  • Radiosurgery / methods*
  • Radiosurgery / standards
  • Radiosurgery / trends
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Trigeminal Nerve / pathology
  • Trigeminal Nerve / physiopathology
  • Trigeminal Nerve / surgery*
  • Trigeminal Neuralgia / etiology*
  • Trigeminal Neuralgia / physiopathology
  • Trigeminal Neuralgia / surgery*