Management strategies of trigeminal neuralgia related to arteriovenous malformation: Five case reports and a review of the literature.

Abstract

Trigeminal neuralgia (TN) accompanied by flow-related changes in the arteriovenous malformations (AVMs) that cause vascular compression of the trigeminal nerve displayed distinct clinical features, and the management of this disease is under disputed. This is a report of our experience with 5 patients who presented with TN due to vascular compression associated with brain AVMs between January 2018 and December 2023. The patients were treated with microvascular decompression (MVD), percutaneous balloon compression (PBC), and radiofrequency thermocoagulation (RFT). Moreover, we searched the PubMed and Embase databases using the keywords "arteriovenous malformation" and "trigeminal neuralgia". These prior publication data were processed and used in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We evaluated the clinical and radiological features and outcomes. The study included 4 males and 1 female, ranging in age from 42 to 68 years, who were diagnosed with TN associated with unruptured AVMs. With respect to treatment, 2 patients were treated with MVD, 1 patient was treated with RFT, 1 patient was treated with PBC, and 1 patient was treated with PBC and RFT. All patients experienced pain relief during the follow-up period. A total of 59 patients (35 males [60%] and 23 females [40%]; one was not available) were identified in the literature between January 1968 and January 2024; these patients presented with TN due to flow-related changes in the AVMs feeding vessels. Among the 44 patients who underwent treatment for brain AVMs, 15 (34%) underwent resections, 14 (32%) underwent stereotactic radiosurgery, 7 (16%) underwent embolization, and 8 (18%) underwent multimodality treatment. Based on our institutional experience and literature review, AVM-directed and TN-directed treatments provide effective pain relief for patients with TN secondary to AVM-related vascular compression.