Chen Joseph C T, Chao Kuo, Rahimian Javad
Department of Neurological Surgery, Southern California Permanente Medical Group, 4950 Sunset Boulevard, Los Angeles, CA, USA.
Division of Interventional Radiology, Southern California Permanente Medical Group, 4950 Sunset Boulevard, Los Angeles, CA, USA.
J Clin Neurosci. 2017 Apr;38:87-90. doi: 10.1016/j.jocn.2016.12.026. Epub 2017 Jan 16.
Stereotactic radiosurgery is a commonly used method for treatment of trigeminal neuralgia. Radiation has been known to be a factor in the later development of aneurysms. Aneurysms have been reported to occur after radiation delivered in a variety of methods including both externally delivered radiation radiosurgery and brachytherapy. We report here an incidence of a de novo aneurysm presenting following radiosurgery treatment for trigeminal neuralgia. The patient was treated using frame-based LINAC radiosurgery receiving 90Gy to the mid cisternal extent of the nerve via a 4mm conical collimator. The patient presented with progressive hypoesthesia 11years after treatment. Imaging evaluation demonstrated the presence of an aneurysm abutting the treated trigeminal nerve. The aneurysm was successfully coil embolized. The patient's facial hypoesthesia, however, did not improve following embolization. We believe that this is the first report of such an aneurysm occurring after radiosurgery for trigeminal neuralgia. De novo aneurysms are a recognized long term complication of radiotherapy and radiosurgery treatment. This report shows such aneurysms can occur with very small treatment volumes. Late sensory changes following radiosurgery for trigeminal neuralgia should prompt workup for de novo aneurysms as well as other late adverse radiation effects.
立体定向放射外科是治疗三叉神经痛的常用方法。已知辐射是动脉瘤后期发生的一个因素。据报道，在通过多种方法进行辐射后会出现动脉瘤，这些方法包括外部放射治疗性放射外科和近距离放射治疗。我们在此报告一例在三叉神经痛放射外科治疗后出现的新发动脉瘤。该患者使用基于框架的直线加速器放射外科治疗，通过4毫米锥形准直器对神经的脑池中部给予90Gy剂量。患者在治疗11年后出现进行性感觉减退。影像学评估显示存在一个毗邻治疗过的三叉神经的动脉瘤。该动脉瘤成功进行了弹簧圈栓塞。然而，栓塞后患者的面部感觉减退并未改善。我们认为这是三叉神经痛放射外科治疗后出现此类动脉瘤的首例报告。新发动脉瘤是放射治疗和放射外科治疗公认的长期并发症。本报告表明，此类动脉瘤可在治疗体积非常小的情况下发生。三叉神经痛放射外科治疗后的晚期感觉变化应促使对新发动脉瘤以及其他晚期放射不良反应进行检查。
