Please cite this article in press as: Parise M, et al. Decision-making in classic trigeminal neuralgia concurrent with a pontine cavernous malformation: Causal or coincidental association? Neurocirugia. 2014. http://dx.doi.org/10.1016/j.neucir.2014.09.003 ARTICLE IN PRESS NEUCIR-152; No. of Pages 5 n e u r o c i r u g i a . 2 0 1 4; x x x(x x) :xxx–xxx NEUROCIRUGÍA www .elsevier.es/neurocirugia Case Report Decision-making in classic trigeminal neuralgia concurrent with a pontine cavernous malformation: Causal or coincidental association? Maud Parise a,b,* , Marcus André Acioly b , Maurice Vincent a,c , Emerson Leandro Gasparetto a a Department of Radiology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil b Department of Surgical Specialties, Division of Neurosurgery, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil c Department of Neurology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil a r t i c l e i n f o Article history: Received 27 April 2014 Accepted 6 September 2014 Available online xxx Keywords: Trigeminal neuralgia Neurovascular compression Brainstem cavernous malformation a b s t r a c t Trigeminal neuralgia is classically associated with neurovascular compression of the trigem- inal nerve, at the root entry zone (REZ). However, patients are occasionally affected by intra-axial involvement of trigeminal sensory fibers caused by demyelinating diseases, strokes and, rarely, pontine cavernous malformations. We discuss the management strate- gies and decision-making process in a 55-year-old patient, affected by trigeminal neuralgia with 2 potential causative mechanisms: a neurovascular conflict at the trigeminal REZ and an ipsilateral cavernous malformation at the pontine nucleus of the trigeminal nerve. © 2014 Sociedad Espa ˜ nola de Neurocirugía. Published by Elsevier España, S.L.U. All rights reserved. La toma de decisiones en la clásica neuralgia del trigémino concurrente con una malformación cavernosa pontina: ¿causa o asociación fortuita? Palabras clave: Neuralgia del trigémino Compresión neurovascular Malformación cavernosa del tronco cerebral r e s u m e n La neuralgia del trigémino está clásicamente asociada con la compresión neurovascular del nervio trigémino, en la zona de entrada de la raíz (REZ). Sin embargo, los pacientes son ocasionalmente afectados por la implicación intra-axial de las fibras sensitivas del trigémino causadas por enfermedades desmielinizantes, accidentes cerebrovasculares, y raramente por malformaciones cavernosas pontinas. Se discuten las estrategias y la toma de * Corresponding author. E-mail addresses: parise@infolink.com.br, maud.parise@gmail.com (M. Parise). http://dx.doi.org/10.1016/j.neucir.2014.09.003 1130-1473/© 2014 Sociedad Espa ˜ nola de Neurocirugía. Published by Elsevier España, S.L.U. All rights reserved.