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Table of Contents    
Year : 2018  |  Volume : 66  |  Issue : 2  |  Page : 514-515

Pseudoaneurysm as a late complication of gamma knife surgery for trigeminal neuralgia

Department of Medicine, Kettering Medical Center, Kettering, Ohio, USA

Date of Web Publication15-Mar-2018

Correspondence Address:
Dr. Peter Bouz
Department of Medicine, Kettering Medical Center, Kettering, Ohio
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.227291

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How to cite this article:
Pak S, Cha D, Valencia D, Askaroglu Y, Short J, Bouz P. Pseudoaneurysm as a late complication of gamma knife surgery for trigeminal neuralgia. Neurol India 2018;66:514-5

How to cite this URL:
Pak S, Cha D, Valencia D, Askaroglu Y, Short J, Bouz P. Pseudoaneurysm as a late complication of gamma knife surgery for trigeminal neuralgia. Neurol India [serial online] 2018 [cited 2020 Jun 4];66:514-5. Available from:


Trigeminal neuralgia (TN) is a chronic pain disorder, affecting one or more branches of the trigeminal nerve. TN manifests as bursts of sudden, stabbing, and severe pain lasting for only a few seconds.[1] This disorder is mostly caused by compression of the trigeminal nerve by vascular structures, most often the superior cerebellar artery.[1] Medications used for TN include carbamazepine, phenytoin, oxcarbazepine, lamotrigine, and gabapentin. Surgical interventions available include Gasserian ganglion block, nerve avulsion, retrogasserian rhizotomy, peripheral nerve block, and gamma knife radiosurgery (GKRS).[1] GKRS is minimally invasive, holds a reasonable efficacy for facial pain relief (59–94%), and can be performed on an outpatient basis, It is, therefore, gaining popularity among clinicians and patients alike.[2],[3] Here, we present a case of an 81-year old male patient who developed pseudoaneurysm as a late complication of GKRS administered for the treatment of TN.

An 81-year old male patient presented with sudden-onset numbness and tingling in his right arm associated with profound right-sided weakness. Medical history was notable for GKRS performed for TN 8 years prior to his presentation. On examination, the patient was found to have a right-sided facial nerve palsy and severe left-sided sensory deficits. Computed tomography (CT) of the brain demonstrated an acute thalamic infarct and a hyperdense mass lesion (2.7 × 1.6 cm) at the cerebellopontine (CP) angle on the right side. The patient was treated with tissue plasminogen activator (tPA) which resulted in complete resolution of symptoms and neurological deficits. At this time, the mass-lesion detected on the computed tomographic (CT) scan was thought to be a malignant lesion.

Approximately 1 month later, the patient experienced a syncopal episode which lasted for about 5 min without any prodromal symptoms. He also described progressively worsening headaches and ataxia over the last month. His blood pressure was 107/76 mmHg, heart rate was 79/min, respiration rate was 17/min, and oxygen saturation was 95% on room air. Physical examination again showed a mild facial nerve palsy and sensory deficits in the V1 and V2 distribution on the right side and profound ataxia. A repeat CT scan of the head showed a right cerebellopontine (CP) angle mass lesion measuring 3 × 2 cm [Figure 1], which had increased in size from its previous measurement of 2.7 × 1.6 cm. Emergent neuroangiography revealed a large fusiform pseudoaneurysm on the superior cerebellar artery. Endovascular coil embolization of the pseudoaneurysm and its parent artery was performed to prevent further enlargement of the pseudoaneurysm. One month after the procedure, the patient reported significant improvement in his headache and ataxia.
Figure 1: Computerized tomography (CT) scan visualizing a hyperdense mass lesion in the right cerebellopontine angle, measuring 3.0 × 1.8 cm

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Our patient had previous GKRS for TN which we suspect ultimately led to a right superior cerebellar artery pseudoaneurysm. We suspect tPA administered for the ischemic stroke may have worsened the pseudoaneurysm. Delayed development of a pseudoaneurysm following GKRS is an overlooked complication with potentially devastating outcome. To the best of authors' knowledge, only a few cases of pseudoaneurysm as a late complication of GKRS are reported in the literature [Table 1].[4],[5]
Table 1: Cases of gamma knife radiosurgery-induced cerebral aneurysm or pseudoaneurysm

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Written informed consent was obtained from the patient.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Chen G, Wang X, Wang L, Zheng J. Arterial compression of nerve is the primary cause of trigeminal neuralgia. Neurol Sci 2014;35:61-6.  Back to cited text no. 1
Elaimy AL, Lamm AF, Demakas JJ, Mackay AR, Lamoreaux WT, Fairbanks RK, et al. Gamma knife radiosurgery for typical trigeminal neuralgia: An institutional review of 108 patients. Surg Neurol Int 2013;4:92.  Back to cited text no. 2
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Elaimy AL, Hanson PW, Lamoreaux WT, Mackay AR, Demakas JJ, Fairbanks RK, et al. Clinical outcomes of gamma knife radiosurgery in the treatment of patients with trigeminal neuralgia. Int J Otolaryngol 2012;2012:919186.  Back to cited text no. 3
Uchikawa H, Nishi T, Kaku Y, Goto T, Kuratsu J-I, Yano S. delayed development of aneurysms following gamma knife surgery for trigeminal neuralgia: Report of 2 cases. World Neurosurg 2017;99:813.e13-813.e19.  Back to cited text no. 4
Chen JC, Chao K, Rahimian J. De novo superior cerebellar artery aneurysm following radiosurgery for trigeminal neuralgia. J Clin Neurosci 2017;38:87-90.  Back to cited text no. 5


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  [Table 1]


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