Trigeminal neuralgia secondary to arteriovenous malformations of the posterior fossa.

ABSTRACT

BACKGROUND: Trigeminal neuralgia secondary to a posterior fossa AVM has been seldom reported in the literature. Most of the cases have been published on a case report basis, and there is not a general agreement about the best way of treatment. METHODS: In this work, we analyze our experience with 5 cases of TN secondary to a posterior fossa AVM, treated at the Division of Neurosurgery from the National Institute of Neurology and Neurosurgery, "Manuel Velasco Suarez," Mexico City, Mexico, from January 1985 to December 2004. RESULTS: Trigeminal neuralgia associated with an AVM occurred in 1.3% of 375 brain AVMs and 9.8% of 37 posterior fossa AVMs. All had received drug therapy unsuccessfully, and 2 of them underwent a percutaneous thermocoagulation without solving the neuralgia. In 4 patients, a microvascular decompression was completed with excellent results. CONCLUSIONS: Even when different ways of treatment have been reported, it seems that percutaneous procedures (glycerol injection, thermocoagulation, or microcompression of the gasserian ganglia) give variable clinical results. The reported experience and our own results support the microvascular decompression of the trigeminal nerve as the best treatment whenever the total excision of the AVM cannot be accomplished.