Contralateral trigeminal neuralgia arising due to CSF leak after microvascular decompression surgery for unilateral trigeminal neuralgia

Abstract

Background: We describe a case of contralateral trigeminal neuralgia (TGN) that developed within a short time after posterior cranial fossa surgery for unilateral TGN. Case description: A 68-year-old woman with right unilateral TGN was treated by microvascular decompression (MVD). Cerebrospinal fluid (CSF) leakage was noted postoperatively, and computed tomography (CT) revealed a large amount of air in the posterior fossa. Sixteen days later, TGN gradually developed on the left side. On MVD around 2.5 months after the first surgery, the contralateral trigeminal nerve was found to be covered by a thick adherent arachnoid membrane with the superior cerebellar artery (SCA) that was stretched but did not compress the root entry zone (REZ). Pain was resolved completely after surgery. Conclusions: Bilateral TGN developed within a short time after first MVD in this case. Contralateral TGN may have been triggered by over tilting of the 5th cranial nerve axis caused by subsidence of the cerebellar cortex due to CSF leakage.

Keywords

• Bilateral trigeminal neuralgia
• Cerebrospinal fluid leakage
• Microvascular decompression