Venous neurovascular conflict in trigeminal neuralgia: A case series of developmental venous anomalies

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.