title: Persistent trigeminal artery supply to an intrinsic trigeminal nerve arteriovenous malformation: a rare cause of trigeminal neuralgia.
abstract: Infratentorial arteriovenous malformations (AVM) associated with the trigeminal nerve root entry zone are a known cause of secondary trigeminal neuralgia (TN). The treatment of both TN and AVM can be challenging, especially if the AVM is embedded within the trigeminal nerve. A persistent trigeminal artery (PTA) can rarely supply these intrinsic trigeminal nerve AVM. We present a 64-year-old man with TN from a right trigeminal nerve AVM supplied by a PTA variant. The patient underwent microvascular decompression and a partial resection of the AVM with relief of facial pain symptoms. His residual AVM was subsequently treated with CyberKnife radiosurgery (Accuray, Sunnyvale, CA, USA). A multimodality approach may be required for the treatment of trigeminal nerve associated PTA AVM and important anatomic patterns need to be recognized before any treatment. Herein, we report to our knowledge the third documented patient with a posterior fossa AVM supplied by a PTA and the first PTA AVM presenting as facial pain.
authors: Department of Neurosurgery, R281, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA.
authors: Omar
authors: O
authors: Choudhri
authors: Department of Radiology, Stanford University Medical Center, Stanford, CA, USA.
authors: Jeremy J
authors: JJ
authors: Heit
authors: Department of Neurosurgery, R281, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA.
authors: Abdullah H
authors: AH
authors: Feroze
authors: Department of Neurosurgery, R281, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA.
authors: Steven D
authors: SD
authors: Chang
authors: Department of Neurosurgery, R281, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA; Department of Radiology, Stanford University Medical Center, Stanford, CA, USA.
authors: Robert L
authors: RL
authors: Dodd
authors: Department of Neurosurgery, R281, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA. Electronic address: gsteinberg@stanford.edu.
authors: Gary K
authors: GK
authors: Steinberg
mesh_terms: D002536:Cerebral Arteries / Q000473:pathology* / Q000601:surgery; D003131:Combined Modality Therapy; D005157:Facial Pain / Q000209:etiology; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000473:pathology* / Q000601:surgery; D008297:Male; D061145:Microvascular Decompression Surgery; D008875:Middle Aged; D016634:Radiosurgery; D016896:Treatment Outcome; D020433:Trigeminal Nerve Diseases / Q000150:complications / Q000473:pathology* / Q000601:surgery; D014277:Trigeminal Neuralgia / Q000209:etiology / Q000473:pathology* / Q000601:surgery
keywords: Arteriovenous malformation; Persistent trigeminal artery; Radiosurgery; Trigeminal neuralgia