Dai Xuan, Xu Dongyuan, Chen Keyu, Cai Yuankun, Mei Zhimin, Wu Ji, Shen Lei, Yang Jingyi, Xiong Nanxiang
Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
Heliyon. 2024 Apr 22;10(9):e30000. doi: 10.1016/j.heliyon.2024.e30000. eCollection 2024 May 15.
Trigeminal neuralgia (TN) secondary to a dural arteriovenous fistula (DAVF) is quite rare, and the goal of treatment is to resolve both the fistula and the pain.
We herein report a case of TN secondary to a DAVF in a 64-year-old woman with a 1-year history of right-sided TN. Brain magnetic resonance imaging and digital subtraction angiography showed a right tentorial DAVF. Interventional embolization was performed, but the pain was not relieved after the operation. Six months later, we performed microvascular decompression of the trigeminal nerve. During the operation, we electrocoagulated the tortuous and dilated malformed vein, which was compressing the trigeminal nerve, to reduce its diameter and mitigate the compression on the cisternal segment of the trigeminal nerve. That patient's pain was relieved postoperatively. In addition, we reviewed the literature of TN caused by DAVF and found a total of 30 cases, 22 of which were treated by interventional embolization. Of these 22 cases, the interventional embolization healed the fistula with pain relief in 14 cases and healed the fistula without pain relief in 8 cases. We found that the venous drainage methods of the 8 cases were all classified into the posterior mesencephalic group.
We believe that this drainage pattern contributes to the more common occurrence of unrelieved pain. For such patients, microvascular decompression can be performed with intraoperative coagulation to narrow the dilated veins until the cisternal segment of the trigeminal nerve is no longer compressed. Satisfactory curative effects can be obtained using this technique.
硬脑膜动静脉瘘（DAVF）继发的三叉神经痛（TN）非常罕见，治疗的目标是解决瘘管问题并缓解疼痛。
我们在此报告一例64岁女性DAVF继发TN的病例，该患者有1年右侧TN病史。脑部磁共振成像和数字减影血管造影显示右侧小脑幕DAVF。进行了介入栓塞，但术后疼痛未缓解。6个月后，我们对三叉神经进行了微血管减压术。手术过程中，我们电凝了压迫三叉神经的迂曲扩张的畸形静脉，以减小其直径并减轻对三叉神经脑池段的压迫。该患者术后疼痛缓解。此外，我们回顾了DAVF引起的TN的文献，共发现30例，其中22例接受了介入栓塞治疗。在这22例中，介入栓塞使瘘管愈合且疼痛缓解的有14例，使瘘管愈合但疼痛未缓解的有8例。我们发现这8例的静脉引流方式均归类为中脑后部组。
我们认为这种引流模式导致疼痛未缓解的情况更为常见。对于此类患者，可在术中进行微血管减压并电凝，以缩小扩张的静脉，直至三叉神经脑池段不再受压。使用该技术可获得满意的疗效。
