Pipeline embolization device for treatment of atypical facial pain caused by a cavernous sinus aneurysm

We present the case of a 53-year-old woman who presented with left-sided atypical facial pain in the V1-V2 distribution of the trigeminal nerve. Further imaging workup revealed a left-sided cavernous aneurysm compressing the V1 and V2 roots of the trigeminal nerve. She was treated with endovascular flow diversion to reduce aneurysmal mass effect, and at six-month follow-up she had near-complete resolution of her pain with significant size reduction of the aneurysm. Accurate localization of a lesion along the course of the trigeminal nerve is important to elucidate the underlying cause of facial pain and therefore guide appropriate management. Cavernous sinus aneurysms resulting in trigeminal nerve compression with resulting facial pain are amenable to treatment with flow diversion with the Pipeline Embolization Device.