gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Intraneural angioma of the trigeminal nerve causing trigeminal neuralgia – Use of endoscope-assisted technique: case report

Meeting Abstract

  • C. Rosenstengel - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Greifswald
  • S. Fleck - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Greifswald
  • H.W.S. Schroeder - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Greifswald

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocP15-12

doi: 10.3205/09dgnc421, urn:nbn:de:0183-09dgnc4216

Published: May 20, 2009

© 2009 Rosenstengel et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: We report an unusual case of a 60-year-old woman who presented with an angioma located within the trigeminal nerve and causing trigeminal neuralgia. The value of the endoscope-assisted microsurgical technique is shown.

Methods: The complaints were described as a therapy resistant pain in the region of the nerve V3 on the left side for almost 2 years. In the CISS-sequence images MRI revealed an atypical vascular configuration suggesting both arterial and venous compression in the nerve root entry zone and a displacement of the superior cerebellar artery. After performing a retrosigmoid craniotomy, the trigeminal cistern was microsurgically explored. An atypical vascular pattern was recognized within the trigeminal nerve root. The endoscopic inspection with 30° and 70° scopes clearly revealed an intraneural vascular malformation. A coagulation of the malformation and microvascular decompression of the superior cerebellar artery loop were performed. During the whole operation BAEP- and facial nerve monitoring were performed.

Results: During the coagulation of the angioma, bleeding from an arterial feeder at the ventral side of the nerve occurred which was difficult stop without injuring the nerve fibers. Postoperatively, the patient suffered from a trigeminal hypoesthesia and trochlear palsy. Three months after surgery the trochlear palsy had resolved and the hypoesthesia almost completely disappeared. To date, the patient is free from pain.

Conclusions: In patients with trigeminal neuralgia a vascular malformation in the nerve root entry zone at the brainstem should be considered as a rare cause for this pathology. The use of the endoscope enabled a much better inspection of the nerve root entry zone and revealed arterial feeders at the ventral side of the nerve which were difficult to see with the microscope alone.