Resolution of trigeminal neuralgia after palliative embolization of a cerebellopontine angle arteriovenous malformation

Background: Trigeminal neuralgia (TN) is a syndrome with debilitating paroxysmal facial pain, one cause of which is thought to be vascular compression of the nerve root entry zone causing ephaptic transmission. Arteriovenous malformations (AVM) have been reported to cause TN, including AVMs in the cerebellopontine (CP) angle. These lesions have been successfully treated with endovascular coiling, ethylene-vinyl alcohol copolymer (Onyx) and surgery for decompression. Case description: We present a case of TN caused by AVM in the CP angle in a patient who was not a candidate for microsurgery and who did not want radiofrequency treatment or other destructive procedures because he would not tolerate facial numbness. The patient's symptoms were successfully treated by embolization using an ethylene-vinyl alcohol copolymer. After 17 months he had a recurrence of pain which was again treated with palliative embolization and again experienced resolution of his symptoms. Conclusion: This case demonstrates that palliative embolization is a safe and effective option for the treatment of trigeminal neuralgia pain in patients for whom surgery of the AVM is not an option.