Stereotactic radiosurgery for arteriovenous malformations presenting as secondary trigeminal neuralgia: a case series

Stereotactic radiosurgery (SRS) is a potential treatment for trigeminal neuralgia (TN) secondary to arteriovenous malformations (AVMs), though its efficacy and safety remain unclear due to the rarity of this condition. We analyzed 1211 brain AVM cases treated with Gamma Knife radiosurgery (GKRS) between 2005 and 2023 at our institution. Four patients (0.33%) were presented with TN secondary to AVM. Three patients received single-fraction GKRS while one underwent hypofractionated treatment. Treatment outcomes were assessed using magnetic resonance imaging, digital subtraction angiography, and the Barrow Neurological Institute pain intensity scale. The mean marginal dose and AVM volume were 21.5 Gy and 0.58 cc, respectively. The mean follow-up period was 85.75 months. Complete AVM obliteration was achieved in all patients, with all experiencing complete pain relief within a mean time of 18 months, enabling gradual discontinuation of medications. No radiation-related adverse effects were observed. Our literature review identified only 15 previously reported cases where SRS was used as primary treatment for TN secondary to AVM, with most cases showing favorable outcomes in pain relief and AVM obliteration. This study is the first case series to demonstrate the sole use and efficacy of GKRS in managing TN secondary to AVM, moving beyond individual case reports. SRS appears to be a safe and effective primary treatment option for TN secondary to AVM, particularly when conventional surgical approaches are contraindicated or pose excessive risks. The sustained pain relief and absence of complications in our series, combined with previous case reports, support its use in managing this rare condition.