Resolution of trigeminal neuralgia following cerebellar AVM embolization with Onyx

Intracranial arteriovenous malformation (AVM) is a rare cause of trigeminal neuralgia (TN). Successful resolution of AVM-related TN following embolization surgery using Onyx has not been reported. In this case report, a posterior fossa AVM was embolized in two separate, staged endovascular surgeries using Onyx. The AVM was reduced in size, and the TN resolved. The patient subsequently underwent radiosurgery for the small, residual AVM, and he has maintained an uneventful follow-up. A thorough literature review was also performed for AVM-associated TN. Fifty-nine reports of AVM-related TN have been described to date, of which only three were treated with embosurgery. None of the prior two embosurgical reports utilized Onyx, and no AVM was obliterated with embosurgery alone. TN secondary to AVM can be resolved with embosurgery utilizing Onyx; however, complete elimination of the underlying AVM requires adjuvant surgery.