Kikuchi K, Kamisato N, Sasanuma J, Watanabe K, Kowada M
Neurosurgical Service, Akita University.
Neurol Med Chir (Tokyo). 1990;30(11 Spec No):918-21. doi: 10.2176/nmc.30.918.
A 45-year-old male was admitted for evaluation of left facial pain of 11-years' duration. Fifteen years prior to admission, he had had an episode of subarachnoid hemorrhage. Neurological examination revealed no definite abnormalities except for trigeminal neuralgia involving the left second division of the nerve. Computed tomography scan showed an irregular enhanced lesion involving the lateral aspect of the left cerebellar hemisphere. Vertebral angiograms revealed an arteriovenous malformation (AVM) fed by both the dilated left anterior inferior cerebellar (AICA) and superior cerebellar arteries (SCA) and draining into the superior petrosal and transverse sinuses via three enlarged draining veins. A saccular aneurysm was incidentally visualized at the proximal portion of the dilated AICA. The AVM was successfully extirpated through the left retromastoid craniectomy. The trigeminal nerve was directly compressed both rostrally and caudally at its entry zone by two dilated feeding arteries of the SCA and the AICA. The aneurysm was simultaneously obliterated. The postoperative course was uneventful, and the excruciating facial pain completely subsided. Postoperative angiograms confirmed disappearance of both the AVM and the aneurysm. Posterior fossa AVMs causing trigeminal neuralgia in the literature are reviewed, and the association of the AVM and the aneurysm in the posterior fossa is also discussed.
一名45岁男性因左侧面部疼痛11年入院评估。入院前15年，他曾发生过一次蛛网膜下腔出血。神经系统检查除左侧三叉神经第二支受累的三叉神经痛外，未发现明确异常。计算机断层扫描显示左侧小脑半球外侧有一个不规则强化病变。椎动脉血管造影显示一个动静脉畸形（AVM），由扩张的左侧小脑前下动脉（AICA）和小脑上动脉（SCA）供血，并通过三条扩张的引流静脉汇入岩上窦和横窦。在扩张的AICA近端偶然发现一个囊状动脉瘤。通过左侧乳突后颅骨切除术成功切除了AVM。三叉神经在其进入区的头侧和尾侧被SCA和AICA的两条扩张供血动脉直接压迫。同时闭塞了动脉瘤。术后病程顺利，剧烈的面部疼痛完全缓解。术后血管造影证实AVM和动脉瘤均消失。本文回顾了文献中导致三叉神经痛的后颅窝AVM，并讨论了后颅窝AVM与动脉瘤的关联。
