Trigeminal radicular arteriovenous fistula presenting as trigeminal neuralgia treated with endovascular therapy.

Background: This report presents a rare case of trigeminal neuralgia (TN) caused by a radicular arteriovenous fistula (AVF).

Case description: A 58-year-old woman presented with severe pain in the right lower jaw, typical of TN. Magnetic resonance imaging showed a vascular signal near the trigeminal nerve. Direct surgery revealed tortuous vessels on the dorsal surface of the nerve, with no offending vessels identified at the root entry zone. Digital subtraction angiography (DSA) confirmed a radicular AVF fed by the trigeminocerebellar artery, with venous drainage into the superior petrosal sinus through the petrosal vein. Endovascular embolization with n-butyl cyanoacrylate resulted in complete obliteration of the fistula and symptom resolution. Although a small pontine infarction occurred, no long-term deficits were observed. Follow-up DSA confirmed no recurrence.

Conclusion: To the best of our knowledge, this represents the first documented case of a trigeminal radicular AVF, highlighting the importance of recognizing vascular anomalies and efficacy of endovascular treatment in managing TN.