Matsushige Toshinori, Nakaoka Mitsuo, Ohta Keiji, Yahara Kaita, Okamoto Hisayo, Kurisu Kaoru
Department of Neurosurgery, Matsue Red Cross Hospital, Matsue, Shimane 690-8506, Japan.
Surg Neurol. 2006 Nov;66(5):519-23; discussion 523. doi: 10.1016/j.surneu.2006.01.022. Epub 2006 Jul 21.
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.
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.
Stereotactic radiosurgery can play an effective role as a treatment modality for such unusual dAVMs.
小脑幕动静脉畸形（dAVM）作为三叉神经痛的病因极为罕见。由于此类高流量dAVM出血风险高，因此对于其进行根治性治疗已达成共识。作者报告了一例50岁男性患者，其因小脑幕dAVM出现三叉神经痛症状，并通过立体定向放射外科治疗（SRS）成功治愈。
该患者因右侧三叉神经痛1个月前来就诊。脑血管造影显示岩骨小脑幕区域存在一个dAVM，磁共振成像（MRI）显示扩张的岩骨静脉瘤压迫右侧三叉神经的神经根入区。采用伽玛刀手术，边缘剂量为18 Gy，最大剂量为30 Gy，照射体积为0.3 mL。该患者放射外科治疗的靶点是通过超选择性血管造影、增强计算机断层扫描和MRI确定的瘘口。伽玛刀手术（GKS）1年后的随访MRI显示病变血栓形成，患者能够停药。在3年的随访中未发现复发或不良反应的迹象。
立体定向放射外科作为此类罕见dAVM的一种治疗方式可发挥有效作用。
