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|LETTERS TO EDITOR
|Year : 2018 | Volume
| Issue : 3 | Page : 852-853
Trigeminal neuralgia caused by a venous angioma: The neuroimaging and surgical findings
Arslan Aydan1, Ulus Sila1, Berkman Z Mehmet2, Karaarslan Ercan1
1 Department of Radiology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
2 Department of Neurosurgery, Acibadem Maslak Hospital, Istanbul, Turkey
|Date of Web Publication||15-May-2018|
Dr. Arslan Aydan
Department of Radiology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Aydan A, Sila U, Mehmet BZ, Ercan K. Trigeminal neuralgia caused by a venous angioma: The neuroimaging and surgical findings. Neurol India 2018;66:852-3
Trigeminal neuralgia (TN) caused by a venous angioma is a rare entity.,, Venous angioma (VA), also known as a developmental venous anomaly, is the most common congenital venous malformation. An umbrella-like convergence of multiple venules representing the enlarged parenchymal or medullary veins, resembling the trunk of a tree or the shank of an umbrella, is noted on contrast-enhanced magnetic resonance imaging (MRI) or computed tomography (CT) images. A preoperative MRI of the posterior fossa is helpful in the identification of the main etiologies of TN, and can delineate the entire course of the trigeminal nerve, especially its cisternal segment. We report a case of TN caused by a VA and describe the neuroimaging and surgical findings.
A 47-year old female patient with pain over the left cheek for the last 22 years, presented to our Neurosurgery department. She had been treated conservatively and with radiofrequency ablation of the trigeminal ganglion; however, her pain had not diminished. Hypoesthesia in the left V2-V3 nerve territory was detected on her neurological examination. MRI was performed on a 3-Tesla scanner (Siemens Magnetom Skyra, Erlanger, Germany). The scanning included standard non-contrast T1-weighted (W) spin echo, T2-W spin echo, T2-W fat sat spin echo (T2-FSE), susceptibility weighted imaging (SWI), fluid attenuation inversion recovery (FLAIR), diffusion weighted imaging (DWI), T2-W 3D-SPACE, and post-intraveous contrast sequences. In addition, three-dimensional time-of-flight (TOF) MR angiography (MRA), time-resolved angiography with interleaved stochastic trajectories (TWIST)-4D-MRA, and non-contrast intracranial magnetic resonance angiography (MRA) were performed. The cranial MRI and MRA with contrast showed abnormally dilated vessels in the left side of the pons and the cerebellar hemisphere, compatible with a VA. SWI images revealed a hypointense signal representing the anomalous veins. The draining vein of these venules was demonstrated next to the entry zone of the trigeminal nerve [Figure 1]a, [Figure 1]b, [Figure 1]c. The MR signal of the nerve was normal. Microvascular decompression (MVD) was performed utilizing a left suboccipital craniotomy and duraplasty. The enlarged venous structure was seen located at the trigeminal nerve entry zone. The arachnoidal adhesions over the trigeminal nerve, and between the VA and the trigeminal nerve were removed, and a barrier was formed between the nerve and the superior cerebellar artery (SCA) with teflon cotton. Intraoperative views are shown in [Figure 2]a, [Figure 2]b, [Figure 2]c, [Figure 2]d. No postoperative complication developed, and the follow-up MRI after 2 months revealed no pathology. MVD is widely accepted as the standard treatment for TN. Review of the literature showed that 12 of the TN cases caused by VA were treated with MVD.
|Figure 1: Prominent venous angioma (arrow) is seen on the left side of pons and cerebellum on SWI (a), contrast-enhanced T1-gradient (b), and thin slice SPACE T2 (c) images. The pressure on the trigeminal nerve pressure is noted at the left trigeminal nerve entry zone|
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|Figure 2: Intraoperative view showing the left cerebellopontine angle. The trigeminal nerve (TN), facial nerve (FN), superior petrosal vein (SPV), superior cerebellar artery (SCA), venous angioma (VA), root entry zone (REZ), and brain stem (BS) are recognizable. Arachnoidal adhesions over the TN and VA are seen (a). The VA is located at the root entry zone of the TN. Arachnoidal adhesions over the TN and around the VA are separated sharply (b). The superior cerebellar artery (SCA) is moved away from the TN (c). Teflon is used to separate the SCA from TN (d)|
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Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]