Dural arteriovenous fistula of the transverse-sigmoid sinus causing trigeminal neuralgia

Abstract

The authors analysed an unusual case of dural arteriovenous fistula (DAVF) of the transverse-sigmoid sinus causing trigeminal neuralgia is presented. Although progression to almost continuous facial pain has been reported, symptoms may be indistinguishable from typical trigeminal neuralgia. The patient had a 6-year history of right-sided trigeminal neuralgia initially well controlled by medical management. He was referred for surgical management after 10 months of progressively worsening of symptoms. At the time of consultation, the patient complained of pulsatile tinnitus in the right ear. Computed tomography imaging and angiography demonstrated a DAVF involving the right transverse-sigmoid sinus junction with retrograde venous drainage. Surgical resection of the DAVF provided both angiographic cure and complete relief of all symptoms. The authors discuss the pathophysiology of trigeminal neuralgia in patients with a DAVF.

Intracranial Hemorrhage from Dural Arteriovenous Fistulas: What Can We Find with CT Angiography?

“…DAVF without cortical venous drainage (CVD) may be asymptomatic or may present with symptoms of increased blood flow in the dural sinus, such as pulsatile tinnitus, particularly common in the case of lesions involving the transverse and sigmoid sinuses [1,2,8,[18][19][20]. Generalized neurological symptoms may be due to venous hypertension or cerebrospinal fluid malabsorption, while other symptoms, such as cranial nerve palsy, often refer to arterial steal or mass effect events caused by an enlarged arterial supply [3,7,21]. Furthermore, if DAVF involves the cavernous sinus, the patient may present severe orbital symptoms, such as chemosis, proptosis and ophthalmoplegia, up to a drastic reduction in visual acuity [1][2][3]19,22].…”

“…According to Lasjaunias et al, there is an important correlation between focal neurological deficit and CVD or venous congestion in the affected vascular territory [7]. However, there may be less frequent severe clinical presentations, such as brain stem or cerebellar dysfunction secondary to venous congestion, Parkinsonism-like symptoms, extra-axial hemorrhage of the cervical spine, as well as cervical and upper thoracic myelopathy [3,7,21,24]. DAVF, especially if accompanied by a very extensive arteriovenous shunt and dural sinus thrombosis, can induce impaired venous drainage from the brain with consensual global venous hypertension [3,25].…”

A rare case of right trigeminal neuralgia due to dural arteriovenous fistula

“…While complete surgical resection is an ideal option for patients with a history of hemorrhage, complete surgical resection may be limited due to the risks associated with certain locations of the fistula. [ 2 3 ] Ott et al . [ 4 ] reported a case of TGN caused by a DAVF that was successfully treated with transarterial embolization.…”

Sacrificing the superior petrosal vein during microvascular decompression. Is it safe? Learning the hard way. Case report and review of literature

“…We performed a review of the international literature and we found that, although rare, this occurrence has been previously described. Specifically, we found nine cases of trigeminal neuralgia due to dural AV fistula[ 1 6 7 10 14 15 17 24 27 ] and five cases of association between trigeminal neuralgia and venous angioma of the posterior cranial fossa. [ 22 23 25 28 33 37 ] In all but one case,[ 7 ] the vascular malformation was suspected with preoperative imaging.…”