• Hiroki Uchikawa, Toru Nishi, Yasuyuki Kaku, Tomoaki Goto, Kuratsu Jun-Ichi JI Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan., and Shigetoshi Yano.
• Division of Neurosurgery, Saiseikai Kumamoto Hospital, Kumamoto, Japan. Electronic address: h.uchikawa.1223@gmail.com.
• World Neurosurg. 2017 Mar 1; 99: 813.e13-813.e19.

BackgroundDelayed 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 DescriptionWe 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.ConclusionLong-term observations are necessary after GKS performed for TN owing to the possibility of formation of intracranial aneurysms near the irradiated region.Copyright © 2016 Elsevier Inc. All rights reserved.

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