Headache Medicine 2021, 12(4):331-337 p-ISSN 2178-7468, e-ISSN 2763-6178

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DOI: 10.48208/HeadacheMed.2021.56

Headache Medicine

Case Report

Trigeminal neuralgia secondary to arteriovenous malformation in

the brainstem: a case report and a brief review

Luiz Severo Bem Junior

1,2,3

, Joaquim Fechine de Alencar Neto

, Júlio Augusto Lustosa Nogueira

Nivaldo Sena Almeida

1,2,3

, Hildo Rocha Cirne de Azevedo Filho

College of Medical Sciences, Unifacisa University Center, Campina Grande, Paraíba, Brazil

Department of Neurosurgery, Hospital da Restauração, Recife, Brazil)

Neuroscience Post-Graduate Program, Federal University of Pernambuco, Recife, Brazil

Abstract

Trigeminal neuralgia, a condition characterized by high intensity, paroxysmal and uni-

lateral pain, can be characterized as secondary when associated with conditions such

as multiple sclerosis and tumors. However, among these secondary cases, there are also

arteriovenous malformations, characterized by a nidus mass of vessels separated by parts

of sclerotic tissues, responsible for a small portion of the neuralgias of the trigeminal nerve.

The case report described is of a 54-year-old male patient who has a brainstem AVM

and refers to lancing and paroxysmal pain in the right hemiface in the territories of V2

and V3 after feeding and brushing the teeth. The treatment of this patient was done from

the insertion of a balloon from the foramen ovale, accessed by the Meckel fossa and the

trigeminal ganglion. The literature review demonstrated, from the analysis of sex, age,

vascularization, localization and treatments of reports of TGN secondary to brainstem

AVM, the reduced number of cases described.

Luiz Severo Bem Junior, MD Neurosur-

gery Department, Restauração Hospi-

tal, Recife, Brazil. Address: Av. Gov.

Agamenon Magalhães, s/n – Derby,

Recife – PE, zipcode: 52171-011.

Email: luizseverobemjunior@gmail.com.

Phone number: +558199248201. Fax

number: none. https://orcid.org/0000-

0002-0835-5995.

Edited by:

Marcelo Moraes Valença

Keywords:

Arteriovenous malformation

Trigeminal neuralgia

Brainstem

Neurosurgery

Vascular malformation

Received: December 01, 2021

Accepted: December 30, 2021

332

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Bem Junior LS, Alencar Neto JF, Nogueira JAL, Almeida NS, Azevedo Filho HRC

Trigeminal neuralgia secondary to arteriovenous malformation in the brainstem: a case report and a brief review

Introduction

he trigeminal nerve is the fth pair of cranial nerves

and originates at the meeting point between the pons

and the middle cerebellar peduncle, being the main nerve

responsible, from its ophthalmic branches (V1), maxillary

(V2) and mandibular (V3), as well as meningeal branches,

for sensation of the head and meninge.

The neuralgia of

the trigeminal nerve, qualied as an acute, sudden, parox-

ysmal, unilateral pain, which can affect one or more nerve

divisions, being characterized by high intensity pain, is re-

sponsible for one of the types of headaches described in the

literature. Trigeminal neuralgia is divided into primary and

secondary. Its classical presentation is characterized by the

neurovascular relationship, from the nerve compression by

vessels, arteries in most cases, process that causes a failure

in the proper conduction of nerve impulses and responsible

for triggering action potentials that initiate pain.

Secondary

neuralgia is caused by space-occupied lesions such as ar-

teriovenous malformation, cavernomas and tumors, or due

to multiple sclerosis causing a process of demyelination of

trigeminal bers, so that external impulses are generated,

and the somatosensory stimulus conducted. The incidence

of neuralgia of the V cranial nerve is higher among men

and increases according to age.

Thus, although rare, the presence of arteriovenous

malformations, characterized by the absence of a

capillary distribution network and by a high blood ow,

in the posterior fossa may be a factor in the generation

of trigeminal neuralgia. The brainstem AVMs, especially

those located in the entry and exit route of the trigeminal

nerve, are the main causes of this neuropathy, although

malformations in other sites may also be generators

of neuropathic pain, in view of the arterial and venous

formation that feeds and drains this nidus of vessels, which

may compress or come into contact with the branches of

the fth cranial pair. Moreover, although supratentorial

and cerebellar AVMs are not common causes for the

generation of trigeminal neuralgia, the vessels that supply

this formation may be related to the onset of the disease,

in spite of this type of malformation is not the focus of this

article discussion.

Thus, this case report with literature review has as main

objective the evaluation of the cases already published

and analyzed about trigeminal neuralgia secondary

to brainstem AVMs, demonstrating the different types of

possible treatments for this condition and the different

clinical manifestations of this situation, which were

collected and united in a table.

Method

The article is a case report with literature review. The

articles reviewed in this study describe other cases

of patients with trigeminal neuralgia secondary to

arteriovenous malformations located in brainstem. The

search and selection of the articles was made from the

analysis of the literature of the PubMed database, between

the months of September 2021 and November 2021.

The keywords of the article are: trigeminal neuralgia,

arteriovenous malformation, nerve compression, brainstem

and neuropathic pain. Pubmed advanced search resources

were used to search and select the advanced search

resources, based on the terms "Trigeminal Neuralgia",

"TGN", "arteriovenous malformation" and "AVM". The

“boolean operators” "AND" and "OR" were used to

lter the articles that were at the intersection of keywords.

The descriptors were crossed to increase the number of

publications. The search in the electronic database was

performed by one of the researchers. The year lter was

dened to select articles between 2000 and 2021, with

21 years of search lter. Inclusion criteria: case report

articles dealing with neuralgia of the trigeminal secondary

to AVM located in brainstem, articles in English and

published in a journal. We found 96 articles, of which

14 met the inclusion criteria. Some of the articles were

selected from bibliographic references of other articles

already found and previously elected during the research

in the database, provided that they obeyed the same

parameters of the inclusion criteria.

Case Report

A patient, male, 54 years old, arrives at the outpatient

service of the Hospital de Ensino e Laboratórios de Pesquisa

(HELP), Campina Grande, complaining of a pain in the

right hemiface, paroxysmal, high intensity, which covered

the territories of V2 and V3, reporting onset and worsening

of the symptom mainly when feeding, talking or brushing

teeth, hindering activities of daily living. According to

the accompanying family member, the pain was of such

intensity that the patient banged his head against the wall.

After cerebral angiography, by means of transfemoral

percutaneous catheterization, the presence of a cortical

pial vascular malformation at the level of the pons, the

right of the basilar groove, tangentially the projection of

the origin of the right trigeminal nerve was identied. The

malformation is about 1.2 cm in greater diameter, supplied

by the right superior cerebellar artery and by a hypertroed

pons branch of the basilar artery. Venous drainage of this

vascular structure is performed by the deep pons venous

branch that drains directly into the right sigmoid sinus.

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Bem Junior LS, Alencar Neto JF, Nogueira JAL, Almeida NS, Azevedo Filho HRC

Trigeminal neuralgia secondary to arteriovenous malformation in the brainstem: a case report and a brief review

The patient started treatment with antiepileptic drugs,

initially with doses of 200 mg of carbamazepine two times

a day. However, when performing activities of daily living

the pain became unbearable. The dose of carbamazepine

was raised to 400 mg three times a day, but pain control

was minimal. Thus, the patient was indicated for a surgical

procedure of trigeminal ganglion compression with

balloon and, after the procedure, the patient reported

a control of 70% of pain and improvement of quality of

life, maintaining the use of carbamazepine 400 mg three

times a day and gabapentin 300 mg two times a day,

managing to stabilize the clinical picture of the patient

who did not report trigeminal pain for two months after

balloon treatment.

Table 1. Articles and case reports of patients with trigeminal neuralgia secondary to AVM of brainstem.

Author/Year Age/Sex AVM Localization Feeding Arteries Drainage Veins

Used drugs and

tretaments

Treatment Therapeutic Effect

Machet, A. et al.

61/Man Upper

cerebellopontine

cistern

R superior cerebellar

artery and the

meningohypophyseal

trunk of the carotid

siphon

Drained into the

R superior petrous

sinus and then into

the R lateral sinus

Carbamazepine

treatment (200

mg × 2/day)

Oxcarbazepine

(450 mg × 3/day)

Only medical

treatment

Facial Pain-free

during the 10-month

follow-up

Machet, A. et al.

64/Woman R Trigeminal REZ Middle cerebellar

artery, the

meningohypophyseal

trunk of the carotid

siphon and the

external carotid artery

(accessory meningeal

artery)

Deep venous system Carbamazepine

(400 mg × 2/day)

Only medical

treatment

Facial Pain-free

during the 18- month

follow-up

Machet, A. et al.

50/Man L Trigeminal REZ L middle cerebellar

artery, the L superior

cerebellar artery and

the inferolateral trunk

of the carotid siphon

_ Carbamazepine

(200 mg × 2/day)

Microcompression

of the gasserian

ganglion was

performed

Facial Pain-free

during 6-month

follow-up

Choudhri, O.

et al.

64/Man R Trigeminal REZ _ _ Carbamazepine for

15 years

Craniotomy and

microvascular

decompression

Complete

symptomatic

relief following

microvascular

decompression

Das, KK. et al.

50/Woman R Trigeminal REZ R anterior inferior

cerebellar artery

(AICA) and a dilated

right intrinsic pontine

artery,

Dilated vein which

was probably

draining into the

superior petrosal

sinus

_ Microvascular

decompression

At 4 years of

follow-up, she was

pain-free without any

medication

Sumioka, S. et al.

66/Man R Trigeminal REZ Branch of the R AICA _ _ Suboccipital

craniotomy and

nidus coagulated

After surgery, the

patient has complete

TN relief

Yip, V. et al.

64/Women Surrounding the R

trigeminal nerve

_ _ Carbamazepine

(300 mg twice a

day) amitriptyline

(10 mg at night)

_ _

Rahme, R. et al.

30/Man Rostral R

cerebello-pontine

angle and mildly

compressing the R

cerebral peduncle

tentorial artery of

Bernasconi and

Cassinari and a

branch of the middle

meningeal artery

Petrosal vein and

into the superior

petrosal sinus

_ R retrosigmoid

lateral suboccipital

approach and

nidus coagulated

Facial Pain-free

during 6-month

follow-up

Simon, SD. et al.

79/Man R-sided

cerebellopontine

angle (CPA)

R superior cerebellar

artery (SCA), the

anterior inferior

cerebellar artery

(AICA), and the

posterior inferior

cerebellar artery

(PICA)

Deep venous

drainage

Carbamazepine Catheterized

through a distal

branch of the

right SCA and

embolized

17 months later

his symptoms had

returned

Ferroli, P. et al.

52/Woman Pontine micro-

AVM

_ _ Carbamazepine

(1200 mg),

phenytoin,

lamotrigine,

gabapentine,

baclofen, and

pregabalin

Microvascular

decompression

1-month after

surgery: pain-free

despite a 50%

reduction in

carbamazepine dose

Anderson, WS.

et al.

39/_ R-sided

cerebellopontine

angle (CPA)

Pontine perforators as

well as the superior

cerebellar artery

R basal vein of

Rosenthal into the

straight sinus

Acetaminophen/

oxycodon (325

mg/10 mg)

carbamazepine

(1500 mg/day)

Gamma Knife

therapy for TN

and AVMs.

Facial Pain-free

during 13-month

follow-up and

had stopped

carbamazepine

treatment

Wanke, I. et al.

57/Man R-sided

cerebellopontine

angle (CPA)

R superior cerebellar

artery

Straight sinus

presumed to be

a dilated lateral

pontomesencephalic

vein

Carbamazepine,

phenytoine and

blockage of the

superior cervical

ganglion.

Intravascular

embolization of

the AVM

No recurrence of

pain was reported

by the patient after

embolisation

García-Pastor, C.

et al.

68/Man L-sided

cerebellopontine

angle (CPA)

_ _ _ _ _

334

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Bem Junior LS, Alencar Neto JF, Nogueira JAL, Almeida NS, Azevedo Filho HRC

Trigeminal neuralgia secondary to arteriovenous malformation in the brainstem: a case report and a brief review

García-Pastor, C.

et al.

54/Woman R-sided

cerebellopontine

angle (CPA)

_ _ _ _ _

Karibe, H. et al.

55/Man Intrinsic to the left

trigeminal nerve

Branch of the superior

cerebellar artery (SCA)

_ Carbamazepine

(800 mg/d)

Decompress

using a prosthesis

without resection

of the AVM

Facial Pain-free

during 2 years

follow-up

Edwards, RJ. et

al.

35/Woman Intrinsic to the

trigeminal nerve

_ _ Carbamazepine Resection of

bAVMs

109-month follow-up/

Recurrence pain 4

years after surgery -

carbamazepine (400

mg/day)

Edwards, RJ. et

al.

38/Man Intrinsic to the

trigeminal nerve

_ _ Carbamazepine Resection of

bAVMs and

microvascular

decompression

Facial Pain-free

during 10-month

follow-up

Edwards, RJ. et

al.

55/Woman Intrinsic to the

trigeminal nerve

_ _ Carbamazepine Resection of

bAVMs

Facial Pain-free

during 64-month

follow-up

Edwards, RJ. et

al.

46/Woman Intrinsic to the

trigeminal nerve

_ _ Carbamazepine Resection of

bAVMs

Facial Pain-free

during 9-month

follow-up

Edwards, RJ. et

al.

36/Woman Intrinsic to the

trigeminal nerve

_ _ Carbamazepine Resection of

bAVMs

Facial Pain-free

during 27-month

follow-up

Son, B. et al.

42/Man R-sided

cerebellopontine

angle (CPA)

Bilateral vertebral

arteries and the R

internal carotid artery

R transverse sinus

and the vein of

Galen via the

precentral vein

_ Percutaneous

radiofrequency

thermocoagulation

and botulinum

toxin injection only

for symptomatic

control (Facial

spams)

Stable along 2

years of follow-up,

with injections of

botulinum toxin

(Facial spasm)

Results

Initially, we searched the case reports on arteriovenous

malformations associated with cases of secondary

trigeminal neuralgia in the PubMed database. Without the

use of language lters, in order to increase the number

of articles published between the years 2000 to 2021,

the terms "arteriovenous malformation", "AVM", "TGN"

and "trigeminal neuralgia" were used to perform the

search and alternated with the operators to achieve more

published articles. At the end of the research, articles that,

despite describing cases of arteriovenous malformation,

but which did not t the case of brainstem AVM, were

discarded from the analysis.

The collection of the collected data was based on the

analysis of the sex and age of the affected patients, with

the objective of evaluating broadly the possible age

group most affected by this condition. The location of the

malformation was one of the most important points of the

analysis, since AVM’s, although they are one of the unusual

causes of trigeminal neuralgia generation

, are often

found and classied as cerebellar, or in another distinct

region, like brainstem, which is the objective of analyzing

this review. In addition, the vessels that feed the vascular

tangle of the AVM and the vessels that drain this complex

were lifted, although they are often not described in the

articles. In view of the possibilities of treatments available

for the treatment of trigeminal neuralgia, from the use

of antiepileptic drug (AED), such as carbamazepine, to

balloon ganglion compression, data related to possible

drugs and previous interventions for which patients

were submitted were collected. Finally, data on the nal

treatment performed by these patients were also collected.

In our literature review, based on the cases found in

PubMed over the 21-year lter, the data collected are found

in Table 1. The review selected 14 articles, among which

were reported 21 cases of patients with TGN secondary

to brainstem AVM. Among these cases, 11 (52.38%) were

male patients and in one of them the patient's sex was

not described. In 12 (57.14%) of the cases collected the

malformation was in regions closely linked to the trigeminal

nerve, among which one part was in the zone of entry

or exit of the nerve root (REZ), and another portion were

AVMs intrinsic to the nerve. In relation to the other cases,

the nidus vessel was located at the cerebellopontine angle

and cerebellum pontine cistern or directly on the pons.

Moreover, although many cases did not describe well the

arteries that participated in this system, among the cases

that describe, in only one of them the AVM was fed by

the branches of the vertebral artery, the others, even if

some presented few branches from the vertebral, were fed

by the branches of the cerebellar arteries. In relation to

venous drainage, there is a great variation, and there may

be drainage to the basal vein of Rosenthal, to the upper

petrous sinus or to a deep drainage system.

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Bem Junior LS, Alencar Neto JF, Nogueira JAL, Almeida NS, Azevedo Filho HRC

Trigeminal neuralgia secondary to arteriovenous malformation in the brainstem: a case report and a brief review

When analyzing the drugs used in previous attempts

to control pain related to trigeminal neuralgia, among

the collected cases, 15 (71.4%) patients used AEDs,

carbamazepine being the most reported of all cases.

In the other reports, no information was available on

the previously submitted treatments. Finally, among

all the reports collected, three did not describe the

form of treatment and recovery of the patient after this

intervention. Analyzing among the cases that described

the type of treatment adopted, the vast majority, 16

(88.88%) underwent surgical treatment with vascular

resection/decompression of arteriovenous malformation,

with distinction of endovascular or craniotomy methods.

The other two cases were submitted only to drug treatment

for pain control. Regarding the therapeutic effect of this

intervention, the two who were submitted only to drug

treatment remained 10 and 18 years under follow-up

and pain-free. The others also reported non-recurrence of

pain after the surgical procedure, although one of them

continued the use of AED, even if in a reduced dose in

relation to the moment before resection.

Discussion

We can broadly enter arteriovenous malformations as a

communication between vessel, when arteries and veins

are in direct contact, without the connecting capillary bed.

The basic characteristic of a malformation is the presence

of a nidus of dysplastic vessels, fed by an arterial system

and drained by veins that unite directly, creating a system

of high blood ow and with reduced resistance.

The

pathophysiological mechanism that best explains the origin

and organization of an arteriovenous malformation is

based on failure in the embryogenesis process of vascular

formation. Despite this, the possibility of an appearance

of this abnormal communication after a mechanism of

trauma

is also raised.

Posterior fossa AVM represent about 5% to 7% of the

described malformations.

Although the symptoms

are varied according to the vessels that participate in

this tangled and the region where the nidus is located,

broadly, these malformations present as headache and

nausea, but some other signs and symptoms can also be

noticed, such as chronic headache, neurological decits,

characterized by ataxia, problems of cranial nerve pairs,

paresis of limbs and, in some cases, intracranial bleeding,

neurovascular compressions, facial spasms and trigeminal

nerve neuralgia.

22,23

Among the causes for trigeminal neuralgia, vascular

contact with the nerve passage route is one of the main

ones, especially when we think of the upper or anterior

inferior cerebellar arteries. However, demyelinating,

idiopathic and compressive causes, as in the case of AVM,

are also present, despite the lower prevalence.

Among the possibilities of treatment for intervention

on secondary neuralgia there are several possibilities.

Initially, as it is possible to notice in the case of the patient

reported in this article and for those described in Table 1,

there is the possibility of treating this condition by means

of anticonvulsants, such as carbamazepine, through dose

increases for pain control.

4-17

In addition, retrogasserian

glycerol injection, percutaneous embolization of AVM,

gamma-knife treatment, compression balloon placement

in the trigeminal ganglion, radiofrequency rhizotomy

and others can be performed. Each of these treatments

will go several according to the location of the AVM

and its connections. In the case of the patient reported,

considering the risk of postoperative sequel of a procedure

in the brainstem, AVM resection was ruled out.

Conclusion

In general, after this review, the complexity of the

pathophysiology associated with the approach of a

trigeminal neuralgia secondary to an AVM becomes

clear, especially when dealing with malformations that are

difcult to access surgically, such as that of the brainstem.

Based on this discussion and the review, the case report

described in this article demonstrates one of the possible

treatments for the intervention of trigeminal neuralgia

secondary to AVM of the brainstem. In this case, as

reported, due to the patient was refractory to drug treatment

and contraindicated for resection of the malformation, the

trigeminal ganglion compression technique with balloon

was chosen and there was a substantial improvement in

the patient's clinical situation

Thus, in view of the small number of cases described

and the variety of possible treatments, as well the results

of Table 1 shows, it is of great importance to carefully

evaluate the patient who presents this condition, in order

to adapt him or her to the more optimized treatment for

his situation. Finally, this review aims to concatenate

studies and case reports already described in the literature

and contribute to another experience of treatment of an

infrequent neurological disease.

Luiz Severo: Conceptualization, Validation, Formal

analysis, Resources, Project administration, Supervision.

336

ASAA

Bem Junior LS, Alencar Neto JF, Nogueira JAL, Almeida NS, Azevedo Filho HRC

Trigeminal neuralgia secondary to arteriovenous malformation in the brainstem: a case report and a brief review

Joaquim Fechine: Conceptualization, Methodology,

Validation, Formal analysis, Investigation, Resources,

Writing-Original Draft, Project administration, Supervision.

Julio Lustosa: Conceptualization, Validation, Formal

analysis, Resources, Project administration, Supervision.

Nivaldo Sena: Conceptualization, Validation, Formal

analysis, Resources, Project administration, Supervision.

Hildo Rocha Cirne: Conceptualization, Validation, Formal

analysis, Resources, Project administration, Supervision.

Keywords: Arteriovenous malformation, trigeminal

neuralgia, brainstem, neurosurgery, vascular malformation.

Declaration of interests: The authors declare that they

have no known competing nancial interests or personal

relationships that could have appeared to inuence the

work reported in this paper.

Financial support and sponsorship: This article has not

received any kind of nancial support.

Acknowledgment: We are grateful to the masters of Hospital

da Restauração who provided insight and expertise that

greatly assisted the research and actively stimulated the

search for answers.

Abbreviations List:

AVM, Arteriovenous malformation

TGN, Trigeminal neuralgia

HELP, Hospital de Ensino e Laboratórios de Pesquisa

REZ, Root entry/exit zone

CPA, Cerebelopontine angle

SCA, Superior cerebellar artery

PICA, Postero-inferior cerebelar artery

AICA, Antero-inferior cereberlar artery

AED, Antiepileptic drugs

Luiz Severo Bem Junior

https://orcid.org/0000-0002-0835-5995

Joaquim Fechine de Alencar Neto

https://orcid.org/0000-0003-2042-4874

Júlio Augusto Lustosa Nogueira

https://orcid.org/0000-0002-4464-8015

Nivaldo Sena Almeida

https://orcid.org/0000-0003-0925-8473

Hildo Rocha Cirne de Azevedo Filho

https://orcid.org/0000-0002-1555-3578

References

1. Gambeta E, Chichorro JG and Zamponi GW.

Trigeminal neuralgia: An overview from

pathophysiology to pharmacological treatments.

Mol Pain

2020;16:1744806920901890

Doi:10.1177/1744806920901890

2. Cruccu G, Finnerup NB, Jensen TS, Scholz J, Sindou

M, Svensson P, . . . Nurmikko T. Trigeminal neuralgia:

New classification and diagnostic grading for

practice and research.

Neurology

2016;87(2):220-

228 Doi:10.1212/wnl.0000000000002840

3. Maarbjerg S, Di Stefano G, Bendtsen L and

Cruccu G. Trigeminal neuralgia - diagnosis and

treatment.

Cephalalgia

2017;37(7):648-657

Doi:10.1177/0333102416687280

4. Machet A, Aggour M, Estrade L, Chays A

and Pierot L. Trigeminal neuralgia related to

arteriovenous malformation of the posterior fossa:

three case reports and a review of the literature.

Neuroradiol

2012;39(1):64-69 Doi:10.1016/j.

neurad.2011.08.001

5. Choudhri O, Heit JJ, Feroze AH, Chang SD, Dodd

RL and Steinberg GK. Persistent trigeminal artery

supply to an intrinsic trigeminal nerve arteriovenous

malformation: a rare cause of trigeminal neuralgia.

Clin Neurosci

2015;22(2):409-412 Doi:10.1016/j.

jocn.2014.06.007

6. Das KK, Gosal JS, Ashish K, Gandhi A, Jaiswal AK and

Behari S. Trigeminal Neuralgia from an Arteriovenous

Malformation of the Trigeminal Root Entry Zone with

a Flow-Related Feeding Artery Aneurysm: The Role

of a Combined Endovascular and "Tailored" Surgical

Treatment.

Neurol India

2021;69(3):744-747

Doi:10.4103/0028-3886.319235

7. Sumioka S, Kondo A, Tanabe H and Yasuda S.

Intrinsic arteriovenous malformation embedded in

the trigeminal nerve of a patient with trigeminal

neuralgia.

Neurol Med Chir (Tokyo)

2011;51(9):639-

641 Doi:10.2176/nmc.51.639

8. Yip V, Michael BD, Nahser HC and Smith D.

Arteriovenous malformation: a rare cause of

trigeminal neuralgia identified by magnetic

resonance imaging with constructive interference in

steady state sequences.

Qjm

2012;105(9):895-898

Doi:10.1093/qjmed/hcr141

9. Rahme R, Ali Y, Slaba S and Samaha E. Dural

arteriovenous malformation: an unusual cause

of trigeminal neuralgia.

Acta Neurochir (Wien)

2007;149(9):937-941; discussion 941 Doi:10.1007/

s00701-007-1251-9

10. Simon SD, Yao TL, Rosenbaum BP, Reig A and Mericle

RA. Resolution of trigeminal neuralgia after palliative

embolization of a cerebellopontine angle arteriovenous

malformation.

Cent Eur Neurosurg

2009;70(3):161-

163 Doi:10.1055/s-0029-1215567

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Bem Junior LS, Alencar Neto JF, Nogueira JAL, Almeida NS, Azevedo Filho HRC

Trigeminal neuralgia secondary to arteriovenous malformation in the brainstem: a case report and a brief review

11. Ferroli P, Acerbi F, Broggi M and Broggi G.

Arteriovenous micromalformation of the trigeminal

root: intraoperative diagnosis with indocyanine

green videoangiography: case report.

Neurosurgery

2010;67(3 Suppl Operative):onsE309-310;

discussion onsE310 Doi:10.1227/01.

Neu.0000381769.15291.4c

12. Anderson WS, Wang PP and Rigamonti D. Case of

microarteriovenous malformation-induced trigeminal

neuralgia treated with radiosurgery.

J Headache Pain

2006;7(4):217-221 Doi:10.1007/s10194-006-0306-

13. Wanke I, Dietrich U, Oppel F and Puchner MJ.

Endovascular treatment of trigeminal neuralgia caused

by arteriovenous malformation: is surgery really

necessary?

Zentralbl Neurochir

2005;66(4):213-216

Doi:10.1055/s-2005-836601

14. García-Pastor C, López-González F, Revuelta R

and Nathal E. Trigeminal neuralgia secondary to

arteriovenous malformations of the posterior fossa.

Surg Neurol

2006;66(2):207-211; discussion 211

Doi:10.1016/j.surneu.2006.01.027

15. Karibe H, Shirane R, Jokura H and Yoshimoto T.

Intrinsic arteriovenous malformation of the trigeminal

nerve in a patient with trigeminal neuralgia: case

report.

Neurosurgery

2004;55(6):1433

16. Edwards RJ, Clarke Y, Renowden SA and Coakham HB.

Trigeminal neuralgia caused by microarteriovenous

malformations of the trigeminal nerve root entry

zone: symptomatic relief following complete

excision of the lesion with nerve root preservation.

J Neurosurg

2002;97(4):874-880 Doi:10.3171/

jns.2002.97.4.0874

17. Son BC, Kim DR, Sung JH and Lee SW. Painful tic

convulsif caused by an arteriovenous malformation.

Clin Neuroradiol

2012;22(4):365-369 Doi:10.1007/

s00062-012-0167-9

18. Lesley WS. Resolution of trigeminal neuralgia

following cerebellar AVM embolization with Onyx.

Cephalalgia

2009;29(9):980-985 Doi:10.1111/

j.1468-2982.2008.01828.x

19. Lawton MT, Rutledge WC, Kim H, Stapf C, Whitehead

KJ, Li DY, . . . Spetzler RF. Brain arteriovenous

malformations.

Nat Rev Dis Primers

2015;1:15008

Doi:10.1038/nrdp.2015.8

20. Lawton MT, Jacobowitz R and Spetzler RF.

Redefined role of angiogenesis in the pathogenesis

of dural arteriovenous malformations.

Neurosurg

1997;87(2):267-274 Doi:10.3171/

jns.1997.87.2.0267

21. Batjer H and Samson D. Arteriovenous malformations

of the posterior fossa: clinical presentation, diagnostic

evaluation and surgical treatment.

Neurosurg Rev

1986;9(4):287-296 Doi:10.1007/bf01743635

22. Silber MH, Sandok BA and Earnest Ft. Vascular

malformations of the posterior fossa. Clinical and

radiologic features.

Arch Neurol

1987;44(9):965-969

Doi:10.1001/archneur.1987.00520210059020

23. Dujovny M, Osgood CP, Faille R, Bennett MH and

Kerber C. Posterior fossa AVM producing hemifacial

spasm: a case report.

Angiology

1979;30(6):425-

432 Doi:10.1177/000331977903000606

24. Jannetta PJ. Neurovascular compression in

cranial nerve and systemic disease.

Ann Surg

1980;192(4):518-525 Doi:10.1097/00000658-

198010000-00010