Treatment outcomes of dural arteriovenous fistula presenting as trigeminal neuralgia: a systematic review and pooled analysis of 53 reported cases.

Abstract

Objective: Dural arteriovenous fistulas (dAVFs) are rare vascular malformations that can mimic trigeminal neuralgia (TN), particularly in patients' refractory to medical therapy. This systematic review aimed to characterize the clinical and angioarchitectural features of dAVFs presenting as TN and to evaluate treatment outcomes across published cases.

Methods: Following PRISMA guidelines, we conducted a systematic review of English language literature up to December 2024. Fifty-three published cases of dAVFs presenting with TN-like symptoms were included. Extracted variables included demographics, Borden classification, arterial feeders, venous drainage, treatment modalities, and clinical outcomes. Descriptive and subgroup analyses were performed to identify factors influencing therapeutic success.

Results: The median age at diagnosis was 56 years, with a male predominance (64.2%). Borden type I fistulas were most common (39.6%). Endovascular embolization was the primary treatment in 60.4% of cases and achieved complete pain relief in 71.9%. Early intervention (≤ 1 year from symptom onset) significantly (p < 0.05) improved outcomes (82.6% complete relief vs. 52.9% in delayed cases). Multimodal treatment (combined embolization and surgical approaches) was often required for high-grade or anatomically complex lesions. Complications occurred in 10 of 53 cases (18.9%) and were generally minor and transient.

Conclusions: dAVFs should be considered in patients with atypical or refractory TN. Early diagnosis, detailed angiographic evaluation, and tailored intervention especially with endovascular embolization offer high rates of pain relief and low complication risk.