■继发于硬脑膜动静脉瘘(DAVF)的三叉神经痛(TN)非常罕见,治疗的目标是解决瘘管和疼痛。
■我们在此报告一例64岁女性的DAVF继发TN,有1年右侧TN病史。脑磁共振成像和数字减影血管造影显示右侧幕膜DAVF。进行了介入栓塞,但是手术后疼痛没有缓解。六个月后,我们进行了三叉神经微血管减压术。在操作过程中,我们电凝弯曲扩张的畸形静脉,压迫三叉神经,以减小其直径并减轻对三叉神经脑池段的压迫。该患者的疼痛在术后得到缓解。此外,我们回顾了DAVF引起的TN的文献,共发现30例,其中22例采用介入栓塞治疗。在这22个案例中,介入栓塞治疗瘘管疼痛缓解14例,未缓解8例。我们发现8例患者的静脉引流方法均归入后中脑组。
■我们认为,这种引流方式有助于更常见的未缓解疼痛。对于这样的患者,微血管减压术可以进行术中凝血,以缩小扩张的静脉,直到三叉神经的脑池段不再被压缩。使用该技术可以获得满意的疗效。
UNASSIGNED: Trigeminal neuralgia (TN) secondary to a dural arteriovenous fistula (DAVF) is quite rare, and the goal of treatment is to resolve both the fistula and the pain.
UNASSIGNED: We herein report a
case of TN secondary to a DAVF in a 64-year-old woman with a 1-year history of right-sided TN. Brain magnetic resonance imaging and digital subtraction angiography showed a right tentorial DAVF. Interventional embolization was performed, but the pain was not relieved after the operation. Six months later, we performed microvascular decompression of the trigeminal nerve. During the operation, we electrocoagulated the tortuous and dilated malformed vein, which was compressing the trigeminal nerve, to reduce its diameter and mitigate the compression on the cisternal segment of the trigeminal nerve. That patient\'s pain was relieved postoperatively. In addition, we reviewed the literature of TN caused by DAVF and found a total of 30 cases, 22 of which were treated by interventional embolization. Of these 22 cases, the interventional embolization healed the fistula with pain relief in 14 cases and healed the fistula without pain relief in 8 cases. We found that the venous drainage methods of the 8 cases were all classified into the posterior mesencephalic group.
UNASSIGNED: We believe that this drainage pattern contributes to the more common occurrence of unrelieved pain. For such patients, microvascular decompression can be performed with intraoperative coagulation to narrow the dilated veins until the cisternal segment of the trigeminal nerve is no longer compressed. Satisfactory curative effects can be obtained using this technique.