Delayed Development of Aneurysms Following Gamma Knife Surgery for Trigeminal Neuralgia: Report of 2 Cases

World Neurosurg. 2017 Mar:99:813.e13-813.e19. doi: 10.1016/j.wneu.2016.11.069. Epub 2016 Nov 24.

Abstract

Background: Delayed development of intracranial aneurysms is an extremely rare complication of gamma knife surgery (GKS), with only 6 cases been reported to date. There are no reported cases after GKS performed to treat trigeminal neuralgia (TN). Of the 6 aforementioned cases, none referred to the natural history or pathophysiology of GKS-related intracranial aneurysm formation.

Case description: We treated 2 patients with subarachnoid hemorrhage (SAH) resulting from rupture of an intracranial aneurysm that developed long after GKS. Case 1 involved a 77-year-old man who had undergone GKS to treat recurrent TN after microvascular decompression surgery. At 13 years after the GSK, he developed SAH from a ruptured left anterior inferior cerebellar artery in close vicinity to the left trigeminal nerve. He died from a premature rupture before intervention could be instituted. Case 2 involved a 72-year-old woman who developed SAH at 9 years after undergoing GKS for TN. A ruptured left superior cerebellar artery aneurysm was treated successfully with endovascular occlusion of the parent artery. She recovered well after the surgery, and was discharged to the rehabilitation hospital with a modified Rankin Scale score of 2.

Conclusion: Long-term observations are necessary after GKS performed for TN owing to the possibility of formation of intracranial aneurysms near the irradiated region.

Keywords: Aneurysm; Gamma knife; Trigeminal neuralgia.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Aneurysm, Ruptured / diagnostic imaging
  • Aneurysm, Ruptured / etiology*
  • Cerebellum / blood supply
  • Cerebral Angiography
  • Female
  • Humans
  • Imaging, Three-Dimensional
  • Intracranial Aneurysm / diagnostic imaging
  • Intracranial Aneurysm / etiology*
  • Magnetic Resonance Angiography
  • Male
  • Microvascular Decompression Surgery
  • Radiation Injuries / diagnostic imaging
  • Radiation Injuries / etiology*
  • Radiosurgery / adverse effects*
  • Subarachnoid Hemorrhage / diagnostic imaging
  • Subarachnoid Hemorrhage / etiology*
  • Time Factors
  • Tomography, X-Ray Computed
  • Trigeminal Neuralgia / radiotherapy*