Ahmed Nazmin, Rahman Asifur, Chavda Vishal, Alam Md Morshad, Ahmed Raju, Hossain Md Nazrul, Chaurasia Bipin
Department of Neurosurgery, Ibrahim Cardiac Hospital & Research Institute, Shahbag, 1000, Dhaka, Bangladesh.
Department of Neurosurgery, Bangladesh Medical University, Shahbag, Dhaka, Bangladesh.
Neurosurg Rev. 2025 Sep 17;48(1):644. doi: 10.1007/s10143-025-03799-1.
Dural arteriovenous fistulas (dAVFs) are rare vascular malformations that can mimic trigeminal neuralgia (TN), particularly in patients' refractory to medical therapy. This systematic review aimed to characterize the clinical and angioarchitectural features of dAVFs presenting as TN and to evaluate treatment outcomes across published cases.
Following PRISMA guidelines, we conducted a systematic review of English language literature up to December 2024. Fifty-three published cases of dAVFs presenting with TN-like symptoms were included. Extracted variables included demographics, Borden classification, arterial feeders, venous drainage, treatment modalities, and clinical outcomes. Descriptive and subgroup analyses were performed to identify factors influencing therapeutic success.
The median age at diagnosis was 56 years, with a male predominance (64.2%). Borden type I fistulas were most common (39.6%). Endovascular embolization was the primary treatment in 60.4% of cases and achieved complete pain relief in 71.9%. Early intervention (≤ 1 year from symptom onset) significantly (p < 0.05) improved outcomes (82.6% complete relief vs. 52.9% in delayed cases). Multimodal treatment (combined embolization and surgical approaches) was often required for high-grade or anatomically complex lesions. Complications occurred in 10 of 53 cases (18.9%) and were generally minor and transient.
dAVFs should be considered in patients with atypical or refractory TN. Early diagnosis, detailed angiographic evaluation, and tailored intervention especially with endovascular embolization offer high rates of pain relief and low complication risk.
硬脑膜动静脉瘘（dAVF）是一种罕见的血管畸形，可酷似三叉神经痛（TN），尤其是在药物治疗无效的患者中。本系统评价旨在描述表现为TN的dAVF的临床和血管构筑特征，并评估已发表病例的治疗结果。
按照PRISMA指南，我们对截至2024年12月的英文文献进行了系统评价。纳入了53例发表的表现为TN样症状的dAVF病例。提取的变量包括人口统计学、Borden分类、动脉供血、静脉引流、治疗方式和临床结果。进行描述性和亚组分析以确定影响治疗成功的因素。
诊断时的中位年龄为56岁，男性占优势（64.2%）。Borden I型瘘最常见（39.6%）。60.4%的病例主要治疗方式为血管内栓塞，其中71.9%实现了完全疼痛缓解。早期干预（症状出现后≤1年）显著（p<0.05）改善了治疗结果（完全缓解率为82.6%，而延迟病例为52.9%）。对于高级别或解剖结构复杂的病变，通常需要多模式治疗（联合栓塞和手术方法）。53例中有10例（18.9%）发生并发症，一般为轻微且短暂的。
对于非典型或难治性TN患者应考虑dAVF。早期诊断、详细的血管造影评估和针对性干预，尤其是血管内栓塞，可提供高疼痛缓解率和低并发症风险。
