Robert Thomas, Blanc Raphaël, Ciccio Gabriele, Smajda Stanislas, Redjem Hocine, Fahed Robert, Piotin Michel
Department of Interventional Neuroradiology, Rothschild Foundation Hospital, 25 Rue Manin, Paris 75019, France.
Department of Interventional Neuroradiology, Rothschild Foundation Hospital, 25 Rue Manin, Paris 75019, France.
Clin Neurol Neurosurg. 2015 Nov;138:83-8. doi: 10.1016/j.clineuro.2015.08.004. Epub 2015 Aug 13.
Trigeminal neuralgia (TN) is a rare revealing symptom of dural or cerebral arteriovenous (AV) shunt. Few isolated cases have described the association between TN and arteriovenous shunt. We presented our experience concerning cerebral AV shunt revealed by a TN.
Between 2003 and 2013, 548 brain AV malformations (bAVM) and 268 dural AV fistulas (dAVF) were treated and a retrospective analysis identified 10 consecutive cases with TN. We reviewed their clinical and angiographic data and as well as their outcome after endovascular treatment.
Among the 10 patients, 5 presented a bAVM and 5 a dAVF. TN was contralateral to the AV shunt in 2 cases (20%). The superior petrosal vein (SPV) was arterialized in all cases. An ectasia of the SPV which could explain a compression of the trigeminal nerve was found in two cases only (20%). It seems that a venous hyperpressure in the ponto-trigeminal vein (tributary of the SPV) is responsible of the TN, rather than a compressive mechanism.
Contrary to other publications on this topic, we believe that the venous reflux into tributaries of the superior petrous vein (and in particular the ponto-trigeminal vein) seems to be the first mechanism of the TN rather that the nerve compression.
三叉神经痛（TN）是硬脑膜或脑动静脉（AV）分流的一种罕见的首发症状。仅有少数孤立病例描述了TN与动静脉分流之间的关联。我们介绍了以TN为首发表现的脑动静脉分流的治疗经验。
2003年至2013年间，共治疗了548例脑动静脉畸形（bAVM）和268例硬脑膜动静脉瘘（dAVF），通过回顾性分析确定了10例连续的TN病例。我们回顾了他们的临床和血管造影数据以及血管内治疗后的结果。
10例患者中，5例为bAVM，5例为dAVF。2例（20%）TN位于AV分流的对侧。所有病例中岩上静脉（SPV）均出现动脉化。仅在2例（20%）中发现SPV扩张，这可能解释了三叉神经受压。似乎脑桥三叉神经静脉（SPV的分支）的静脉高压是TN的原因，而非压迫机制。
与关于该主题的其他出版物不同，我们认为静脉血回流至岩上静脉（特别是脑桥三叉神经静脉）的分支似乎是TN的首要机制，而非神经受压。
