Abstract W P418: Trigeminal Neuralgia due to Arterialization of the Superior Petrosal Vein in the Context of Dural or Cerebral Arteriovenous Shunt
Trigeminal neuralgia (TN) was rarely the symptom and the discovery mode of dural or cerebral arteriovenous shunt. Few isolated cases described the association between TN and arteriovenous shunt. We presented our experience concerning cerebral AV shunt revealed by a TN. Between 2003 and 2013, 548 bAVM and 268 dAVF had been treated in our department and retrospective analysis permitted us to identify 10 consecutive cases with TN. We reviewed data from these patients to understand the pathophysiology of the neuralgia. Among the 10 patients (mean range: 37 years), 5 presented a bAVM and 5 a dAVF. TN was contralateral to the AV shunt in 2 cases (20%). AVM nidus was located in the cerebellum in all cases without pontine extension. dAVFs were located in the cerebello-pontine cistern (3 cases) , cerebello-medullary cistern (1 case) or at the free margin of the tentorium (1 case). The superior petrosal vein (SPV) was arterialized in all cases. Only in two cases (20%), an ectasia of the SPV explained TN by compression of the trigeminal nerve DREZ. For other cases (80%), no compression was noted. It seemed that venous hyperpression in the ponto-trigeminal vein (tributary of the SPV) could better explained the TN than a compression. This hypothesis permitted us to understand controlateral side of pain and the correlation between TN and reflux in the latero-mesencephalic vein. Contrary to other publications published on this topic, the compression of the nerve seems not to be the first etiology of the TN but the venous reflux into tributaries of the superior petrous vein and in particular the ponto-trigeminal vein.
Author Disclosures: T. Robert: None. R. Blanc: None. G. Ciccio: None. H. Redjem: None. B. Bartolini: None. S. Pistocchi: None. M. Piotin: None.
- © 2015 by American Heart Association, Inc.