Isolated trigeminal neuralgia secondary to distal anterior inferior cerebellar artery aneurysm

Abstract

A 43-year-old woman complaining of severe pain of the right side of the face was admitted to the Department of Neurosurgery. It had been present for three months and diagnosed as trigeminal neuralgia. The CT scan without contrast material had been considered normal at that time. Three months later, after a favourable response to carbamazepine, she suddenly developed right occipital headache and drowsiness. On admission, she was alert, and neurological examination revealed only mild neck stiffness. Computed tomographic scan demonstrated an acute hematoma in the right cerebellopontine angle and in the fourth ventricle. Vertebral angiography revealed an aneurysm of the right anterior inferior cerebellar artery (AICA). A posterior fossa approach disclosed a large, nearly totally thrombosed, saccular AICA aneurysm, which showed minimal compression to the pons at the trigeminal root entry zone. The aneurysm was clipped and excised. She showed an excellent recovery and was free of pain in the early postoperative period and at the last examination 16 months later. Aneurysms in the distal AICA are very rare lesions. Only 31 cases have been published so far. Distal AICA aneurysm in an extremely unusual cause of trigeminal neuralgia secondary to aneurysmal compression. The literature concerning AICA aneurysms and their clinical manifestations is reviewed and discussed.

Trigeminal neuralgia caused by aneurysm of the posterior cerebral artery: a case description and the analysis of anatomical variety of vascular complex in the rood entry zone of trigeminal nerve

“…Some authors have reported TGN caused by the conflict with aneurysms on the anterior inferior cerebellar artery (AICA), posterior communicating artery and basilar artery (BA) [4,10,13,20,26,27,29]. In most publications there was not isolated idiopathic neuralgia, but the effect of compres- …”

Compression of the Medulla Oblongata and Acute Respiratory Failure Caused by Rupture of a Thrombosed Large Aneurysm of the Anterior Inferior Cerebellar Artery -Case Report-

“…A few cases of thrombosed large AICA aneurysm have been reported, 1,6,7,11,13,16) including local association with acute hematoma. 6,16) One patient complained of sudden onset of occipital headache, nausea, and vomiting, 6) and the other patient suddenly developed facial numbness and headache.…”

“…6,16) One patient complained of sudden onset of occipital headache, nausea, and vomiting, 6) and the other patient suddenly developed facial numbness and headache. 16) The sudden onsets of symptoms indicated rupture of an aneurysm in these cases.…”

“…[2][3][4][5][8][9][10][11][12]14,15,17) Progressive growth of an aneurysm of the AICA generally manifests as various cerebellopontine angle syndromes such as oculomotor nerve palsy, trigeminal sensory loss or neuralgia, sixth cranial nerve palsy, seventh cranial nerve palsy, vertigo, tinnitus, hearing loss, lower cranial nerve palsy, and ataxia. 1,6,7,10,11,13,14,16) Rapid deterioration of neurological symptoms generally indicates rupture of an aneurysm. Subarachnoid hemorrhage may subsequently cause dyspnea, arrhythmia, and death after these cerebellopontine angle syndromes occur.…”

Subarachnoid Hemorrhage Caused by Rupture of a Distal Anterior Inferior Cerebellar Artery Aneurysm -Three Case Reports-

“…15,17) These symptoms result from compression of cranial nerves or the brainstem, and may be prodromal signs of rupture. 4,17) The clinical and neuroimaging features of this unusual lesion have been discussed, but the pathological features and surgical issues have never been thoroughly exam- We report three cases of distal AICA aneurysm manifesting as SAH, and describe direct surgical observations of the vascular structures.…”