Resolution of Trigeminal Neuralgia After Transvenous Embolization of a Cavernous Sinus Dural Arteriovenous Fistula

Kenji Fukutome; Ichiro Nakagawa; Hun Soo Park; Takeshi Wada; Yasushi Motoyama; Kimihiko Kichikawa; Hiroyuki Nakase

doi:10.1016/j.wneu.2016.11.033

Resolution of Trigeminal Neuralgia After Transvenous Embolization of a Cavernous Sinus Dural Arteriovenous Fistula

World Neurosurg. 2017 Feb:98:880.e5-880.e8. doi: 10.1016/j.wneu.2016.11.033. Epub 2016 Nov 17.

Authors

Kenji Fukutome¹, Ichiro Nakagawa², Hun Soo Park¹, Takeshi Wada³, Yasushi Motoyama¹, Kimihiko Kichikawa³, Hiroyuki Nakase¹

Affiliations

¹ Department of Neurosurgery, Nara Medical University, Nara, Japan.
² Department of Neurosurgery, Nara Medical University, Nara, Japan. Electronic address: nakagawa@nmu-gw.naramed-u.ac.jp.
³ Department of Radiology, Nara Medical University, Nara, Japan.

PMID: 27867122
DOI: 10.1016/j.wneu.2016.11.033

Abstract

Background: Trigeminal neuralgia (TN) resulting from a dural arteriovenous fistula (DAVF) are rare. A case of cavernous sinus dural arteriovenous fistula (CSDAVF) in a patient with TN that resolved immediately after transvenous embolization (TVE) is described.

Case description: A 75-year-old woman presented with continuous facial pain. On time-of-flight magnetic resonance angiography (MRA), a CSDAVF was suspected, and digital subtraction angiography (DSA) showed a CSDAVF. The TN completely resolved immediately after TVE, with no recurrence. Follow-up MRA showed complete obliteration of the fistula 13 months after TVE.

Conclusions: The pulsatile flow at the posteromedial part of the cavernous sinus might have compressed the upper aspect of the Gasserian ganglion, causing TN. Disappearance of pulsatile flow after TVE might result in complete resolution of TN.

Keywords: Cavernous sinus dural arteriovenous fistula; Gasserian ganglion; Transvenous embolization; Trigeminal neuralgia.

Publication types

Case Reports

MeSH terms

Aged
Angiography, Digital Subtraction
Cavernous Sinus / diagnostic imaging
Cavernous Sinus / surgery*
Central Nervous System Vascular Malformations / complications*
Central Nervous System Vascular Malformations / diagnostic imaging
Central Nervous System Vascular Malformations / surgery
Embolization, Therapeutic / methods*
Female
Humans
Magnetic Resonance Angiography
Pulsatile Flow / physiology
Trigeminal Neuralgia / diagnostic imaging
Trigeminal Neuralgia / etiology*
Trigeminal Neuralgia / surgery*