Endovascular Palliation of AVM-Associated Intractable Trigeminal Neuralgia via Embolization of the Artery of the Foramen Rotundum

Abstract

Objective. Trigeminal neuralgia is rarely caused by arteriovenous malformations of the posterior fossa. Embolization of aberrant vessels can provide symptomatic relief; however, embolization is not always technically possible, and its effects can be temporary. Embolization of the nerve's blood supply could reduce its excitability and provide pain relief. Setting. The study was set in an academic tertiary care center. Study Design. The study was designed as a report of a clinical case. Summary. The authors report the case of a 13-year-old girl with a large, unruptured posterior fossa arteriovenous malformation (AVM) presented with left-sided V2-division trigeminal neuralgia. She had undergone multiple previous embolizations of feeding vessels from the anterior inferior cerebellar artery with temporary relief of her symptoms. Embolization of the middle meningeal artery was attempted, but the vessel's tortuosity precluded safe catheterization. Instead, the artery of the foramen rotundum, which had minimal contribution to the AVM nidus, was embolized with Onyx copolymer. The patient had immediate cessation of her neuralgia, with a small area of hypesthesia above her left cheek. Complete pain relief lasted for 8 months, followed by a return of mild dysesthesia episodes not requiring intervention. Conclusion. This case may represent a new method of palliative treatment for AVM-associated trigeminal neuralgia, or potentially trigeminal neuralgia of other etiologies. Based on this case's success, a prospective study using additional provocative testing with intraarterial lidocaine is proposed. Wiley Periodicals, Inc.