Du Rose, Binder Devin K, Halbach Van, Fischbein Nancy, Barbaro Nicholas M
Department of Neurological Surgery, University of California, San Francisco, San Francisco, California 94143, USA.
Neurosurgery. 2003 Jul;53(1):216-21; discussion 221. doi: 10.1227/01.neu.0000069535.42897.1f.
Trigeminal neuralgia is often the result of vascular compression at the root entry zone of the trigeminal nerve. We report a case of trigeminal neuralgia in a patient with a dural arteriovenous fistula in Meckel's cave. Endovascular closure of the fistula resulted in elimination of the patient's pain at the gasserian ganglion level.
A 77-year-old woman was referred for treatment of trigeminal neuralgia after failed conservative treatment, including multiple gasserian ganglion blocks. Magnetic resonance imaging of the brain suggested a vascular lesion, and cerebral angiography demonstrated a dural arteriovenous fistula in Meckel's cave.
Endovascular coil embolization was performed, with obliteration of the dural arteriovenous fistula and resolution of facial pain but with decreased sensation in the face.
Trigeminal neuralgia may be associated with complex vascular lesions around the base of the brain and along the course of the trigeminal nerve. The evaluation of patients with trigeminal neuralgia should include high-quality, thin-section, magnetic resonance imaging scans, to exclude the possibility of vascular lesions and other structural lesions. In particular, patients who are being evaluated for surgical treatment of trigeminal neuralgia should undergo magnetic resonance imaging, with a focus on the course of the trigeminal nerve.
三叉神经痛通常是由三叉神经根部进入区的血管压迫所致。我们报告一例在Meckel腔存在硬脑膜动静脉瘘的患者发生三叉神经痛的病例。经血管内封堵瘘口后，患者半月神经节水平的疼痛消失。
一名77岁女性在包括多次半月神经节阻滞在内的保守治疗失败后，因三叉神经痛前来就诊。脑部磁共振成像提示存在血管病变，脑血管造影显示Meckel腔内有硬脑膜动静脉瘘。
实施了经血管内弹簧圈栓塞术，硬脑膜动静脉瘘闭塞，面部疼痛缓解，但面部感觉减退。
三叉神经痛可能与脑底部及三叉神经走行周围的复杂血管病变有关。对三叉神经痛患者的评估应包括高质量的薄层磁共振成像扫描，以排除血管病变和其他结构病变的可能性。特别是正在接受三叉神经痛手术治疗评估的患者，应进行磁共振成像检查，重点关注三叉神经的走行。
