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Neuroimaging
Published in Sarah McWilliams, Practical Radiological Anatomy, 2011
o The deep cerebral veins: the internal cerebral veins that run in the roof of the third ventricle and join to form the vein of Galen. This short vein lies in the quadrigeminal cistern. The vein of Galen joins the inferior sagittal sinus to become the straight sinus.
Endovascular treatment of trigeminal neuralgia with cranial autonomic symptoms due to a right-sided petrous ridge dAVF
Published in British Journal of Neurosurgery, 2021
Thomas Mulcahy, Norman Ma, Kenneth Mitchell
A 51-year-old male with a three year history of severe right-sided facial pain was referred to our clinic. He had previously undergone a C6/7 ACDF and had hypertension but was otherwise well. His presentation was not completely typical of classical TN. The pain was in a right V1 distribution having frequent attacks of recurrent severe pain lasting up to an hour on most days. The pain was also associated with conjunctival injection and tearing of the right eye and a pressure sensation in his head. There was no facial numbness or weakness. Given the presence of autonomic dysfunction, he had previously been diagnosed with SUNCT syndrome. He had failed to respond to medical therapy including, verapamil, propranolol, metoprolol, lithium, amitriptyline, lamotrigine, topiramate and pregabalin, and had only minimal lasting effects from botox and lignocaine infusions. The patient went on to have an MRI (Image 1) that demonstrated a possible right-sided petrous ridge dAVF in close proximity to the right trigeminal nerve root entry zone. On T2 weighted imaging, significant flow voids were noted to abut the right trigeminal nerve REZ. This appeared contiguous with flow voids running along the right petrous ridge. MRI TOF angiography demonstrated a vascular lesion arising from the right ICA and extending along the ipsilateral petrous ridge. There was no cerebral oedema or signal changes within the medulla to indicate venous congestion. Cerebral angiography (Image 2) confirmed a Cognard type 3 right-sided tentorial dAVF supplied by an enlarged meningo-hypophpyseal vessel from the extradural ICA and by the middle meningeal artery. The fistula drains towards the midline via a thickened tentorium to deep cerebral veins, the internal cerebral vein and the straight sinus. There was no evidence of retrograde flow and no venous hypertension or congestion.