Trigeminal neuralgia in a patient with a dural arteriovenous fistula in Meckel's cave: case report.
OBJECTIVE
Trigeminal neuralgia is often the result of vascular compression at the root entry zone of the trigeminal nerve. We report a case of trigeminal neuralgia in a patient with a dural arteriovenous fistula in Meckel's cave. Endovascular closure of the fistula resulted in elimination of the patient's pain at the gasserian ganglion level.


METHODS
A 77-year-old woman was referred for treatment of trigeminal neuralgia after failed conservative treatment, including multiple gasserian ganglion blocks. Magnetic resonance imaging of the brain suggested a vascular lesion, and cerebral angiography demonstrated a dural arteriovenous fistula in Meckel's cave.


METHODS
Endovascular coil embolization was performed, with obliteration of the dural arteriovenous fistula and resolution of facial pain but with decreased sensation in the face.


CONCLUSIONS
Trigeminal neuralgia may be associated with complex vascular lesions around the base of the brain and along the course of the trigeminal nerve. The evaluation of patients with trigeminal neuralgia should include high-quality, thin-section, magnetic resonance imaging scans, to exclude the possibility of vascular lesions and other structural lesions. In particular, patients who are being evaluated for surgical treatment of trigeminal neuralgia should undergo magnetic resonance imaging, with a focus on the course of the trigeminal nerve.
Du
Rose
R
Department of Neurological Surgery, University of California, San Francisco, San Francisco, California 94143, USA. rdu@itsa.ucsf.edu
Binder
Devin K
DK
Halbach
Van
V
Fischbein
Nancy
N
Barbaro
Nicholas M
NM
D000368:Aged; D020785:Central Nervous System Vascular Malformations / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D014277:Trigeminal Neuralgia / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy