脳神経外科速報

Abstract

Distal superior cerebellar artery (SCA) aneurysms are rare, and intracranial aneurysms as a complication of radiotherapy are particularly rare. We report a distal SCA aneurysm after gamma knife radiosurgery (GKRS) for trigeminal neuralgia (TN). An 83-year-old male patient presented with severe headache and vomiting associated with conscious disturbance. He had undergone GKRS for TN 14 years ago, and facial pain was ameliorated after the treatment. On admission, CT scan showed subarachnoid hemorrhage with thick clots in the left cerebellopontine cistern and 3D-CTA showed a left distal SCA aneurysm. Although we treated the aneurysm with complete coil embolization, he died of re-rupture of the aneurysm on postoperative day 19. Our patient had previous GKRS for TN that we suspect ultimately led to a distal SCA aneurysm. Radiation-associated intracranial aneurysm is a rare complication, and its frequency as well as optimal treatment is still controversial. Delayed development of aneurysm is a recognized long-term complication of GKRS, and it may be an overlooked complication with potentially devastating outcome. To the best of our knowledge, this is the second case of aneurysm as a late complication of GKRS reported in the literature.