When treating trigeminal neuralgia with SRS, are there vascular constraints or concern for late aneurysm?

The incidence of cerebral aneurysms after stereotactic radiosurgery (SRS) for trigeminal neuralgia (TGN) is extremely rare. High-dose radiation (60 - 90 Gy) delivered to local microvasculature can theoretically cause focal vessel wall weakening, elastin degeneration, or radiation angiopathy leading to the formation of an aneurysm; however, the incidence is extremely rare, and only isolated case reports of de novo aneurysms or pseudoaneurysms of vessels near the treated trigeminal nerve have been documented (Chung et al., PMID 33264794).

In my personal experience of treating TGN over the past 35 years, I have never encountered a case. However, I do try to minimize the dose to the superior cerebellar artery (SCA), which is commonly co-located ...