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Year : 2018  |  Volume : 66  |  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

Correspondence Address:
Dr. Arslan Aydan
Department of Radiology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul
Turkey




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;66:852-853


How to cite this URL:
Aydan A, Sila U, Mehmet BZ, Ercan K. Trigeminal neuralgia caused by a venous angioma: The neuroimaging and surgical findings. Neurol India [serial online] 2018 [cited 2022 Aug 13 ];66:852-853
Available from: https://www.neurologyindia.com/text.asp?2018/66/3/852/232338


Full Text



Sir,

Trigeminal neuralgia (TN) caused by a venous angioma is a rare entity.[1],[2],[3] 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.[4] 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.[1]{Figure 1}{Figure 2}

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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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2Nagata K, Nikaido Y, Yuasa T, Fujioka M, Ida Y, Fujimoto K. Trigeminal neuralgia associated with venous angioma--case report. Neurol Med Chir (Tokyo) 1995;35:310-3.
3Yamamoto T, Suzuki M, Esaki T, Nakao Y, Mori K. Trigeminal neuralgia caused by venous angioma. Neurol Med Chir 2013;53:40-3.
4Lee C, Pennington MA, Kenney CM 3rd. MR evaluation of developmental venous anomalies: Medullary venous anatomy of venous angiomas. AJNR 1996;17:61-70.