Trigeminal Neuralgia Secondary to Arteriovenous Malformation of the Posterior Fossa: A Case Report and Literature Review

The objective of this study is to analyze a case of trigeminal neuralgia (TN) secondary to intracranial arteriovenous malformation (AVM), summarize reported cases of TN associated with cerebral vascular malformations, and discuss the experience with endovascular and other therapeutic modalities. We analyzed our institutional case of cerebral AVM-induced TN and reviewed relevant literature on trigeminal neuralgia and AVM published between 1968 and 2022. A total of 47 consecutive cases of brain arteriovenous malformations (bAVMs) complicated by TN were identified through retrospective analysis of 47 treated bAVM cases. Clinical data, angiographic findings, and outcomes following endovascular and other treatments were evaluated. Among the 47 patients with TN associated with bAVMs, 11 underwent endovascular embolization: 10 achieved pain relief, and 1 showed initial symptomatic remission. Arterialization and ectasia of the superior petrosal vein (SPV) and its tributaries, which could explain trigeminal nerve compression, were observed in 24 cases. Venous hypertension in the ponto-trigeminal vein (a tributary of the SPV) appears to be one of the etiological factors of TN. Consistent with previous publications, we propose that venous reflux into tributaries of the SPV—particularly the ponto-trigeminal vein—represents a key mechanism of TN caused by nerve compression. Currently, there is no consensus on the optimal treatment for cerebellar AVM-related TN; however, partial interventional embolization of the AVM nidus is considered a viable strategy to reduce blood flow and alleviate symptoms.