Mulcahy Thomas, Ma Norman, Mitchell Kenneth
Department of Neurosurgery, Royal Brisbane and Women's Hospital, Herston, Australia.
School of Clinical Medicine, The University of Queensland, Brisbane, Australia.
Br J Neurosurg. 2023 Oct;37(5):1339-1345. doi: 10.1080/02688697.2021.1874295. Epub 2021 Jan 20.
Dural arteriovenous fistula represents a rare cause of secondary Trigeminal Neuralgia. To date, there have been 18 reported cases of successful treatment of trigeminal neuralgia with endovascular embolization. Here we describe a unique case of a 51-year-old man with right-sided petrous ridge dural arteriovenous fistula causing ipsilateral V1 pain and cranial autonomic dysfunction. Cerebral angiography confirmed a Cognard type 3 right-sided tentorial dAVF supplied by an enlarged meningo-hypophpyseal vessel from the extradural ICA and by the middle meningeal artery. The fistula drains towards the midline via deep cerebral veins, the internal cerebral vein and the straight sinus with likely variceal compression of the right trigeminal nerve root entry zone. Transarterial Onyx embolization resulted in complete obliteration of the dural arteriovenous fistula with immediate resolution of facial pain and autonomic symptoms. After 24 months, the patient remains symptom-free and has no radiographic or clinical evidence of fistula recurrence. To date, there have been no other cases reported of trigeminal neuralgia with cranial autonomic symptoms or SUNCT syndrome due to a dural arteriovenous fistula. The presence of cranial autonomic symptoms with trigeminal neuralgia or a diagnosis of SUNCT should not deter endovascular treatments of dural arteriovenous fistulas or treatment of other compressive vascular lesions.
硬脑膜动静脉瘘是继发性三叉神经痛的罕见病因。迄今为止，已有18例经血管内栓塞成功治疗三叉神经痛的报道。在此，我们描述一例独特的病例，一名51岁男性患有右侧岩嵴硬脑膜动静脉瘘，导致同侧V1区疼痛和颅神经自主功能障碍。脑血管造影证实为Cognard 3型右侧幕下硬脑膜动静脉瘘，由硬膜外颈内动脉增粗的脑膜垂体干血管及脑膜中动脉供血。瘘经由大脑深静脉、大脑内静脉和直窦引流至中线，可能对右侧三叉神经根入区造成静脉曲张性压迫。经动脉使用Onyx栓塞导致硬脑膜动静脉瘘完全闭塞，面部疼痛和自主神经症状立即缓解。24个月后，患者仍无症状，且无瘘复发的影像学或临床证据。迄今为止，尚无其他因硬脑膜动静脉瘘导致三叉神经痛伴颅神经自主症状或短暂性单侧神经痛性头痛发作伴结膜充血及流泪综合征（SUNCT）的病例报道。三叉神经痛伴有颅神经自主症状或诊断为SUNCT，不应妨碍对硬脑膜动静脉瘘进行血管内治疗或对其他压迫性血管病变进行治疗。
