Tentorial dural arteriovenous malformation manifesting as trigeminal neuralgia treated by stereotactic radiosurgery: A case report.
BACKGROUND
Tentorial dAVMs as a cause of trigeminal neuralgia are extremely rare. Consensus exists that radical treatment of such high-flow dAVMs should be considered because of their high risk of bleeding. The authors present a case of a 50-year-old man who presented with symptoms of tic douloureux caused by tentorial dAVM, which was treated successfully by SRS.


METHODS
The patient consulted us with a 1-month history of harboring right trigeminal neuralgia. The cerebral angiography revealed a dAVM in the petrotentorial region and the MRI demonstrated a dilated petrosal venous varix compressing the root entry zone of the right trigeminal nerve. Gamma knife surgery was performed with a marginal dose of 18 Gy and a maximum dose of 30 Gy in a volume of 0.3 mL. The target point of the radiosurgery for this patient was a fistula identified by superselective angiography, enhanced computed tomography, and MRI. Follow-up MRI, 1 year after GKS, showed a thrombosed lesion, and the patient was able to end medication. There was no evidence of recurrence or adverse effects in the 3-year follow-up.


CONCLUSIONS
Stereotactic radiosurgery can play an effective role as a treatment modality for such unusual dAVMs.
Matsushige
Toshinori
T
Department of Neurosurgery, Matsue Red Cross Hospital, Matsue, Shimane 690-8506, Japan. h-k1122@m3.dion.ne.jp
Nakaoka
Mitsuo
M
Ohta
Keiji
K
Yahara
Kaita
K
Okamoto
Hisayo
H
Kurisu
Kaoru
K
D020785:Central Nervous System Vascular Malformations / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000473:pathology; D002550:Cerebral Veins / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000473:pathology; D002560:Cerebrovascular Circulation / Q000502:physiology; D003388:Cranial Fossa, Posterior / Q000033:anatomy & histology / Q000473:pathology / Q000601:surgery; D003392:Cranial Sinuses / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000473:pathology; D004388:Dura Mater / Q000098:blood supply / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000592:standards; D011829:Radiation Dosage; D016634:Radiosurgery / Q000379:methods* / Q000592:standards / Q000639:trends; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014276:Trigeminal Nerve / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D014277:Trigeminal Neuralgia / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*