[Trigeminal neuralgia and tentorial dural arteriovenous malformation]

Combination of trigeminal neuralgia and tentorial dural arteriovenous malformation is extremely rare. The authors present a case of 72-year-old male patient who suffered from left-side trigeminal neuralgia. MRI revealed numerous tortuous vessels in the left parapontine region. The trigeminal root entry zone was explored via retrosigmoid approach. Tentorial dural arteriovenous malformation localized in proximity to superior petrosal sinus with significant enlargement of leptomeningeal cerebellar vessels (Borden type III) was demonstrated. The fistula was clipped and transsected with immediate restoration of bluish color of cerebellar veins. The trigeminal root entry zone was compressed by the loop of superior cerebellar artery and vascular decompression was performed. After surgery patient became pain-free without any neurological complications. This case clearly demonstrated that trigeminal neuralgia associated with tentorial dural atreriofenous malformation may occur not only due to dilated arterialized cerebellar veins but also can be caused by tortuous loop of superior cerebellar artery.