Subarachnoid bleeding into the superior cerebellopontine cistern after radiofrequency trigeminal rhizotomy: case report.

摘要

We would like to report an unusual case of a patient suffering from trigeminal neuralgia, who underwent percutaneous radiofrequency trigeminal rhizotomy (RF-TR), and complicated with subarachnoidal bleeding in the superior cerebellopontine cistern. A 68-year-old woman had been suffering from medically intractable trigeminal neuralgia. She had a 6-year history of trigeminal neuralgia at the ophthalmic and maxillary branches of the left trigeminal nerve. Cranial magnetic resonance imaging scans revealed no structural or vascular abnormality. Routine preoperative analyses, including coagulation studies, were normal. The patient underwent RF-TR under intravenously administered sedation and analgesia. The localization was confirmed within the nerve by electrical stimulation at 0.5 V (100 Hz, 0.2 m); and a lesion was made at a temperature of 70°C for 60 s. After the procedure, the patient's pain resolved completely. However, 12 h after the procedure, sudden onset of severe headache, vomiting and neck stiffness occurred. The initial cranial computed tomography (CT) scan was normal. Lumbar puncture examination revealed bloody cerebrospinal fluid (CSF); the lymphocyte and monocyte proportions were normal. The control cranial CT scan showed subarachnoidal bleeding in the left superior cerebellopontine cistern (Fig. 1). The patient underwent conservative treatment, and neck stiffness and headache improved. She was discharged 7 days after the procedure.