Dural arteriovenous malformation manifesting as Tic douloureux

Abstract

Although cerebral arteriovenous malformation (AVM) is an established cause of trigeminal neuralgia, dural AVM has rarely been reported to cause tic douloureux. Treatment of dural AVM in the tentorial and torcular regions by transarterial embolization is rarely curative. It has recently been proposed that many cranial dural AVMs with leptomeningeal venous drainage require only interruption of the draining vein as it enters the subarachnoid space for successful, lasting elimination. We present a case of 65-year-old man with typical trigeminal neuralgia caused by a dural AVM. Carotid angiography revealed a dural AVM in the petrotentorial region with enlarged and serpiginous draining veins, which compressed the trigeminal nerve. Facial pain had been completely relieved for 2 months after successful transarterial embolization, but the symptom recurred. The patient subsequently underwent surgical interruption of the draining veins just beneath the cerebellar tentorium. The dural AVM disappeared, and the trigeminal neuralgia was completely relieved. The literature concerning the etiology of tic douloureux is reviewed and the selection of treatment modality of this case is discussed. The striking clinical and radiologic improvement in this case emphasizes the pivotal role of simple interruption of the arterialized vein for petrotentorial dural AVMs, which are not amenable to cure by endovascular procedures.