EMBOLIZATION OF A TENTORIAL DURAL ARTERIOVENOUS-FISTULA PRESENTING ASATYPICAL TRIGEMINAL NEURALGIA

A patient with a tentorial dural AV fistula causing atypical trigemina l neuralgia (TN) successfully treated by embolization is reported. The patient developed persisting throbbing facial pain in the distributio n of the second and third division of the right trigeminal nerve (V2,V 3) after a history of typical neuralgia for one year, preceded by a tw o month spell of TN 6 years previously and accompanied by right-sided pulsatile tinnitus for 10 years. The patient's mother, brother and sis ter were also said to be affected by typical trigeminal neuralgia. A r ight-sided dilated vein of Rosenthal due to a dural AV fistula fed by branches of the meningeal, occipital and meningo-hypophyseal trunk of the internal carotid artery was thought to cause trigeminal nerve comp ression. Complete resolution of symptoms after partial intra-arterial embolization of the main feeding arteries with N-butyroacrylate is des cribed.