Aseptic meningitis caused by Teflon implantation for microvascular decompression

Abstract

The authors present the case of a 47-year-old man who, after undergoing microvascular decompression for trigeminal neuralgia, experienced symptomatic pain relief but developed prolonged aseptic meningitis. This case is unusual in that the patient remained dependent on steroid medications for nearly 5 months following the initial surgery and the aseptic meningitis did not resolve until after surgical removal of the Teflon used to pad the trigeminal nerve. The pathophysiological characteristics of the body's reaction to implanted Teflon are discussed along with the rationale for removing this substance in cases of prolonged intractable aseptic meningitis.

Teflon granulomas mimicking cerebellopontine angle tumors following microvascular decompression

“…A), vessels, and the brainstem, and may exert mass effect as they grow, precipitating recurrent facial pain, new‐onset facial numbness, facial paralysis, or hearing loss . Aseptic meningitis, brain abscess, and intracranial cysts leading to neurologic deficits have been described in isolated cases . TG may grow and become symptomatic at variable intervals, ranging from within 1 month to over 8 years following primary surgery .…”

“…10,18 Aseptic meningitis, brain abscess, and intracranial cysts leading to neurologic deficits have been described in isolated cases. 11,21,22 TG may grow and become symptomatic at variable intervals, ranging from within 1 month to over 8 years following primary surgery. 10,18,20 Our cases reflect this variable and potentially protracted natural history, as one patient developed symptoms within 1 year, whereas the other remained asymptomatic for 9 years after the initial operation.…”

Transposition of the Vertebral Artery With Fibrin Glue Adhesive in Microvascular Decompression

“…[2][3][4] Although several methods for vascular transposition were reported, most of them required complicated microsurgical techniques, including suture and passing a tape around the artery. Safety is the most important issue in this procedure.…”

Polytetrafluoroethylene-Induced Granuloma and Brainstem Cyst After Microvascular Decompression for Trigeminal Neuralgia

“…Cryotherapy (49), percutaneous radiofrequency thermo- (12), and gamma knife radiosurgery (40) have been used in patients who fail medical therapy. The preferred surgical treatment for severe refractory cases in patients judged at low risk for major surgery is MVD of the trigeminal nerve, which involves separating the offending vessel from the nerve root entry zone with a synthetic material (2,4,5,6,7,11,20,26,27,30,31,34,36,38,45,48). Neurosurgeons have used PTFE, Ivalon (Ivalon Inc., San Diego, CA), Gelfoam (Pfizer Inc., New York, NY), Dacron (Invista Inc., Wichita, KS), cotton, periosteum, muscle, and fascia (29,35,44).…”

“…PTFE is preferred for MVD because it is inert and devoid of adhesion properties, inflammatory response, adverse reactions, and potential for scarring in the nervous system (1). However, foreign body reaction with granuloma formation causing recurrent symptoms, hearing loss, ataxia, and meningitis have been described (5,6,7,15,34,38).…”