Trigeminal neuralgia associated with cerebellar pial arteriovenous fistula: A case report

Trigeminal neuralgia (TN) is frequently associated with compression at the root entry zone of the trigeminal nerve by an aberrant loop of an artery, tributaries of the petrosal vein, tumors, aneurysm, and vascular malformation. TN associated with a cerebellar pial arteriovenous fistula (PAVF) has not been described previously. A 65-year-old man presented with right-sided TN. Cerebral angiography revealed a right cerebellar PAVF and magnetic resonance imaging demonstrated a mixed compression of the petrous vein complex and anterior inferior cerebellar artery at the right trigeminal nerve. Due to the patient's symptoms, radiographic findings, he was diagnosed with TN and PAVF. Coiling combined with use of the liquid embolic agent Onyx was used for the complete embolization of the fistula. Complete relief of the pain was achieved 3 months after endovascular treatment, and the patient has remained pain-free during 2 years of follow-up. Endovascular treatment with a combination of coils and Onyx embolization is an effective approach for complete resolution of rarely occurring TN caused by mixed venous and arterial compressions associated with cerebellar PAVF.