Polytetrafluoroethylene-induced granuloma and brainstem cyst after microvascular decompression for trigeminal neuralgia: case report.
OBJECTIVE
Microvascular decompression is commonly performed for medically refractory trigeminal neuralgia. A piece of polytetrafluoroethylene (PTFE) is usually placed between the trigeminal nerve and the blood vessel causing the compression. The procedure is effective and relatively safe, and PTFE is presumed to be inert. Reactions to PTFE are rare.


METHODS
We report a patient who developed progressive neurological symptoms 5 years after microvascular decompression surgery. Imaging showed an enhancing cerebellopontine mass resembling a posterior fossa tumor with a large cyst compressing the brainstem.


METHODS
Craniotomy was performed to decompress the cyst. Biopsy of the enhancing mass showed granulomatous inflammation. The patient underwent a second brainstem decompression surgery with placement of a catheter in the cyst connected to an Ommaya reservoir; she has moderate to severe residual neurological deficits.


CONCLUSIONS
This may be the first case of a severely disabling, space-occupying cyst resulting from a reaction to intracranial PTFE. Should this exceptionally rare complication be disclosed to patients or is it an idiosyncratic reaction unlikely to occur again?
Toth
Gabor
G
Department of Neurology, The University of Chicago Medical Center, Chicago, Illinois, USA.
Rubeiz
Helene
H
Macdonald
R Loch
RL
D001933:Brain Stem; D020863:Central Nervous System Cysts / Q000175:diagnosis* / Q000209:etiology; D003560:Cysts / Q000175:diagnosis* / Q000209:etiology; D019299:Decompression, Surgical / Q000009:adverse effects*; D005260:Female; D006099:Granuloma / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008866:Microsurgery / Q000009:adverse effects; D008875:Middle Aged; D011138:Polytetrafluoroethylene / Q000009:adverse effects*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D014277:Trigeminal Neuralgia / Q000473:pathology / Q000601:surgery*
D011138:Polytetrafluoroethylene