• Toshinori Matsushige, Mitsuo Nakaoka, Keiji Ohta, Kaita Yahara, Hisayo Okamoto, and Kaoru Kurisu.
• Department of Neurosurgery, Matsue Red Cross Hospital, Matsue, Shimane 690-8506, Japan. h-k1122@m3.dion.ne.jp
• Surg Neurol. 2006 Nov 1; 66 (5): 519-23; discussion 523.

BackgroundTentorial dAVMs as a cause of trigeminal neuralgia are extremely rare. Consensus exists that radical treatment of such high-flow dAVMs should be considered because of their high risk of bleeding. The authors present a case of a 50-year-old man who presented with symptoms of tic douloureux caused by tentorial dAVM, which was treated successfully by SRS.Case DescriptionThe patient consulted us with a 1-month history of harboring right trigeminal neuralgia. The cerebral angiography revealed a dAVM in the petrotentorial region and the MRI demonstrated a dilated petrosal venous varix compressing the root entry zone of the right trigeminal nerve. Gamma knife surgery was performed with a marginal dose of 18 Gy and a maximum dose of 30 Gy in a volume of 0.3 mL. The target point of the radiosurgery for this patient was a fistula identified by superselective angiography, enhanced computed tomography, and MRI. Follow-up MRI, 1 year after GKS, showed a thrombosed lesion, and the patient was able to end medication. There was no evidence of recurrence or adverse effects in the 3-year follow-up.ConclusionStereotactic radiosurgery can play an effective role as a treatment modality for such unusual dAVMs.

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