Painful Tic Convulsif Caused by an Arteriovenous Malformation

Trigeminal neuralgia secondary to arteriovenous malformation in the brainstem: a case report and a brief review

Trigeminal neuralgia, a condition characterized by high intensity, paroxysmal and unilateral pain, can be characterized as secondary when associated with conditions such as multiple sclerosis and tumors. However, among these secondary cases, there are also arteriovenous malformations, characterized by a nidus mass of vessels separated by parts of sclerotic tissues, responsible for a small portion of the neuralgias of the trigeminal nerve. The case report described is of a 54-year-old male patient who has a brainstem AVM and refers to lancing and paroxysmal pain in the right hemiface in the territories of V2 and V3 after feeding and brushing the teeth. The treatment of this patient was done from the insertion of a balloon from the foramen ovale, accessed by the Meckel fossa and the trigeminal ganglion. The literature review demonstrated, from the analysis of gender, age, vascularization, localization and treatments of reports of TGN secondary to brainstem AVM, the reduced number of cases described.

The Epidemiology, Cause, and Prognosis of Painful Tic Convulsif Syndrome: An Individual Patient Data Analysis of 192 Cases

BACKGROUND

Characterized by the coexistence of trigeminal neuralgia and ipsilateral hemifacial spasm (HFS), painful tic convulsif (PTC) is a rare entity that has not yet been systematically studied.

OBJECTIVE

To systematically explore the epidemiology, cause, prognosis, and prognosis predictors of PTC.

METHODS

We searched PubMed, Web of Science, and the Cochrane Library for relevant studies published between establishment of the library and July 1, 2020. Information on demographics, causes, specific interventions, and intervention outcomes was extracted. We first performed descriptive analysis of demographics, causes, and surgical outcomes of PTC. Univariate and multivariate regression methods were used to explore potential prognosis predictors. Further, a 2-step meta-analysis method was used to validate the identified factors.

RESULTS

Overall, 57 reports including 192 cases with PTC were included in the analysis. The median age of patients with PTC is 54 years (range, 44-62 years), with more patients being female (P < 0.001), initiated as HFS (P = 0.005), and being affected with left side (P = 0.045). The vertebrobasilar artery contributes to >65% of the causes of single vascular compression for PTC. Anterior inferior cerebellar artery/posterior inferior cerebellar artery involvement (odds ratio, 4.050; 95% confidence interval, 1.091-15.031) and older age (P = 0.008) predict freedom from symptoms and recurrence after microvascular decompression, respectively.

CONCLUSIONS

PTC occurs more in middle-aged women between 40 and 60 years old, initiates as HFS, and affects the left side. Vertebrobasilar artery compression is the most common single cause of PTC. Microvascular decompression effectively treated PTC, with a cure rate >80%. Anterior inferior cerebellar artery/posterior inferior cerebellar artery involvement predicts successful surgery and older age predicts recurrence.

Surgical management of coexisting trigeminal neuralgia and hemifacial spasm

Background:

Coexisting hemifacial spasm (HFS) and trigeminal neuralgia (TN) without any mass lesion in the posterior fossa is a rare condition. Hence, the surgical strategy of coexisting HFS and TN has rarely been discussed.

Case Description:

We present a rare case of coexisting HFS and TN without any mass lesion in posterior fossa having microvascular confliction of trigeminal nerve with superior cerebellar artery (SCA) and facial nerve with anterior inferior cerebellar artery (AICA). Single surgery was performed for both trigeminal nerve and facial nerve. Mobilization of vessels and placement of Teflon between the nerve and vessel relieved the symptoms immediately after the operation. We have reviewed the literature for cases with coexistent HFS and TN. The treatment strategy for such cases has been discussed. The surgical treatment has been demonstrated with a video.

Conclusion:

A single surgery is a safe and effective option to treat coexistent HFS and TN due to microvascular confliction.

A multivariate analysis for delayed healing of facial muscle spasm after microvascular decompression

Objectives:

To analyze the related factors for delayed healing of facial muscle spasm after microvascular decompression.

Methods:

After microvascular decompression, 116 of 425 patients with delayed healing were followed up, and their clinical data were analyzed.

Results:

The incidence rate of postoperative delayed healing was 27.3%, which was not correlated with gender, age or intraoperative vascular compression. However, it was correlated with disease course, severity of preoperative symptoms, arteriosclerosis and abnormal facial muscle response. The duration of delayed healing was positively correlated with preoperative disease course.

Conclusions:

Delayed healing is a common phenomenon after microvascular decompression for facial muscle spasm, with an elusive reason. Therefore, the treatment outcomes should be evaluated after one year of follow-up.

Trigeminal neuralgia caused by a dilated superior cerebellar artery and a draining vein of cerebellar arteriovenous malformations: a case report and review of the literature

Trigeminal neuralgia (TN) secondary to arterivenous malformations (AVMs) is relatively rare. We here report on a case of TN caused by cerebellar AVMs that was successfully treated by total AVMs resection in conjunction with microvasecular decompression (MVD) in one stage. In addition, we perform a review of the literature about the treatment of TN caused by cerebellar AVMs.

Trigeminal neuralgia caused by brain arteriovenous malformations: A case report and literature review

Few cases of trigeminal neuralgia (TGN) induced by brain arteriovenous malformations (bAVMs) have previously been reported. The present case report described one case of TGN caused by bAVMs in a 32-year-old male patient who suffered from recurrent pain in his right cheek for a period of two years, for whom the seizure frequency and duration of pain increased for 6 months. Magnetic resonance imaging was performed, which demonstrated flow-void signals in the abnormal vessels in the right cerebellopontine angle. Subsequent digital subtraction angiography confirmed the diagnosis of bAVMs, and showed the nidus was fed by the right superior cerebellar and the right anterior inferior cerebellar, and drained into the adjacent venous sinuses on the same side. The patient underwent an interventional embolization treatment. TGN was completely relieved following embolization of the majority of the bAVMs. Pain relief may be associated with blocking of the pulsatile compression of the feeding arteries of the bAVMs, the arterialized draining veins or the malformed niduses following embolization, which is similar to the effects induced by microvascular decompression surgery of the trigeminal nerve. In the present case study and review, the underlying mechanism and treatment strategy of TGN caused by bAVMs were discussed in the context of present case, and a literature review was carried out.