Venous angioma adjacent to the root entry zone of the trigeminal nerve: implications for management of trigeminal neuralgia.

Detection of a venous angioma at the root entry zone is important for surgical planning, so that the neurosurgeon will be aware that both veins and arteries may require microvascular decompression. In selected cases, alternative treatment may be indicated to avoid the potential surgical complication of a venous infarct. Trigeminal neuralgia typically occurs in the middle-aged to elderly population, usually the result of compression of the trigeminal nerve at its root entry zone by an ectatic, aging artery or, less commonly, a regional vein [1, 2, 3]. When associated with a venous angioma at the root entry zone, trigeminal neuralgia usually presents at a younger age [4, 5, 6]. We review the imaging examinations and clinical data of five patients with trigeminal neuralgia who had a venous angioma adjacent to the root entry zone of the trigeminal nerve, and discuss how the imaging findings affected their management.