Trigeminal Neuralgia After a Cerebrospinal Fluid Leak: A Case Report

Area of Science:

• Neurology
• Neurosurgery
• Radiology

Background:

• Cerebrospinal fluid (CSF) leakage presents diagnostic challenges, often leading to intracranial hypotension and severe positional headaches.
• Brain sagging due to CSF loss can compress cranial nerves, mimicking conditions like Chiari malformation.
• Trigeminal facial pain is an uncommon but significant symptom associated with CSF leakage.

Purpose of the Study:

• To report a case of trigeminal facial pain and positional headache caused by a thoracic spinal cerebrospinal fluid-venous fistula.
• To emphasize the diagnostic utility of advanced imaging in localizing rare CSF leak sources.
• To highlight the effectiveness of surgical intervention for CSF-venous fistulas.

Main Methods:

• Case report detailing a patient with unexplained positional headache and facial pain.
• Utilized advanced diagnostic imaging to identify a thoracic spinal cerebrospinal fluid-venous fistula.
• Surgical intervention to repair the identified fistula.

Main Results:

• The patient presented with intractable positional headache and trigeminal facial pain.
• A thoracic spinal cerebrospinal fluid-venous fistula was diagnosed using advanced imaging.
• Surgical repair of the fistula resulted in complete resolution of headache and facial pain.

Conclusions:

• Thoracic spinal cerebrospinal fluid-venous fistulas are a rare but treatable cause of intracranial hypotension, positional headache, and facial pain.
• Multidisciplinary management and advanced imaging are crucial for accurate diagnosis and successful treatment.
• Surgical intervention is effective in resolving symptoms associated with these fistulas.