Hyper-Acute Necrosis of a Trigeminal Schwannoma After GKRS: A Case Report

Abstract Trigeminal schwannomas (TS) represent 0.8 to 5% of intracranial schwannomas. Due to their localization, surgery has a high morbidity, with stereotactic radiosurgery being a frequent method of treatment with a high control rate. The main side effects due to radiation are pseudoprogression and worsening of the symptoms related to the affected nerve. Despite tumor necrosis, they tend to be progressive, small, and to spread throughout the tumor. We present a rare case of a 48-year-old woman with trigeminal schwannoma who underwent gamma knife radiosurgery and presented with facial pain immediately after the procedure with significant worsening a few hours later. MRI showed necrosis of the medial part of the extracranial extension of the tumor. This is the first report of hyperacute tumor necrosis after radiation for schwannomas.