Venous neurovascular conflict in trigeminal neuralgia: A case series of developmental venous anomalies
https://doi.org/10.64265/3033-649X-2026.2.1.69-76
Abstract
While arterial compression is the predominant cause of trigeminal neuralgia, venous etiologies remain poorly characterized. Developmental venous anomalies (DVA) are generally regarded as benign incidental fi ndings but may occasionally result in symptomatic neurovascular conflict. We report a case series of four patients with trigeminal neuralgia attributed to developmental venous anomalies, focusing on imaging features, underlying pathophysiological mechanisms, and surgical management.
All patients underwent brain magnetic resonance imaging (MRI) using a standardized cranial nerve protocol. MRI demonstrated DVAs with direct venous contact or compression of the trigeminal nerve root entry zone, sometimes associated with nerve thinning, complex venous networks, or altered venous drainage due to chronic venous outfl ow obstruction. Microvascular decompression was performed using tailored, vein-preserving approaches.
Postoperative pain relief was achieved in all four patients; however, postoperative sensory defi cits and late pain recurrence were observed in individual cases. These findings indicate that DVAs can represent a rare but clinically relevant cause of trigeminal neuralgia. Advanced MRI plays a pivotal role in diagnosis and surgical planning, and recognition of venous neurovascular confl ict is essential, particularly in younger patients with atypical imaging findings.
About the Authors
P. I. Trukhachev
Federal Neurosurgical Center
Russian Federation
Russian Federation
Pavel I. Trukhachev– Radiologist
Nemirovicha-Danchenko str., 132/1, Novosibirsk, 630087
E. A. Filimonova
Federal Neurosurgical Center;
Russian Federation
Russian Federation
Elena A. Filimonova – Radiologist, Head of the Department of Radiology; Teaching Assistant of the Department of Neurosurgery
Nemirovicha-Danchenko str., 132/1, Novosibirsk, 630087
Krasny ave., 52, Novosibirsk, 630091
References
1. Nurmikko TJ, Eldridge PR. Trigeminal neuralgia – Pathophysiology, diagnosis and current treatment. Br J Anaesth. 2001; 87(1): 117-132. https://doi.org/10.1093/bja/87.1.117
2. Aoki R, Srivatanakul K. Developmental venous anomaly: Benign or not benign. Neurol Med Chir (Tokyo). 2016; 56(9): 534-543. https://doi.org/10.2176/NMC.RA.2016-0030
3. Samadian M, Bakhtevari MH, Nosari MA, Babadi AJ, Razaei O. Trigeminal neuralgia caused by venous angioma: A case report and review of the literature. World Neurosurg. 2015; 84(3): 860-864. https://doi.org/10.1016/J.WNEU.2015.04.063
4. Peterson AM, Williams RL, Fukui MB, Meltzer CC. Venous angioma adjacent to the root entry zone of the trigeminal nerve: Implications for management of trigeminal neuralgia. Neuroradiology. 2002; 44(4): 342-346. https://doi.org/10.1007/S00234-001-0724-4/METRICS
5. Nagata K, Nikaido Y, Yuasa T, Fujioka M, Ida Y, Fujimoto K. Trigeminal neuralgia associated with venous angioma – Case report. Neurol Med Chir (Tokyo). 1995; 35(5): 310-313. https://doi.org/10.2176/NMC.35.310
6. Yamamoto T, Suzuki M, Esaki T, Nakao Y, Mori K. Trigeminal neuralgia caused by venous angioma – Case report. Neurol Med Chir (Tokyo). 2013; 53(1): 40-43. https://doi.org/10.2176/NMC.53.40
7. Barker FG, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD. The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med. 1996; 334(17): 1077-1084. https://doi.org/10.1056/NEJM199604253341701;PAGEGROUP:STRING:PUBLICATION
8. Broggi G, Ferroli P, Franzini A, Servello D, Dones I. Microvascular decompression for trigeminal neuralgia: Comments on a series of 250 cases, including 10 patients with multiple sclerosis. J Neurol Neurosurg Psychiatry. 2000; 68(1): 59-64. https://doi.org/10.1136/jnnp.68.1.59
9. Damiano TR, Truwit CL, Dowd CF, Symonds DL, Portela L, Dreisbach J. Posterior fossa venous angiomas with drainage through the brain stem. AJNR Am J Neuroradiol. 1994; 15(4): 643-652.
10. Ferro JM, Canhão P, Stam J, Bousser MG, Barinagarrementeria F; ISCVT Investigators. Prognosis of cerebral vein and dural sinus thrombosis: Results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke. 2004; 35(3): 664-670. https://doi.org/10.1161/01.STR.0000117571.76197.26
11. Luo Y, Tian X, Wang X. Diagnosis and treatment of cerebral venous thrombosis: A review. Front Aging Neurosci. 2018; 10(JAN): 319053. https://doi.org/10.3389/FNAGI.2018.00002/FULL
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For citations:
Trukhachev P.I., Filimonova E.A. Venous neurovascular conflict in trigeminal neuralgia: A case series of developmental venous anomalies. Sibneuro. 2026;2(1):69-76. https://doi.org/10.64265/3033-649X-2026.2.1.69-76
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