{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:06:04Z","timestamp":1776096364698,"version":"3.50.1"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"11","license":[{"start":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T00:00:00Z","timestamp":1773619200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,3,16]]},"abstract":"\n BACKGROUND<\/jats:title>\n Teflon (polytetrafluoroethylene) is widely used in microvascular decompression (MVD) for trigeminal neuralgia (TN) as an effective material to separate the offending vessel from the trigeminal nerve. Teflon granuloma develops in approximately 1.1%\u20137.3% of MVD cases and can lead to recurrent TN. However, acute inflammatory Teflon granuloma\u2014characterized by an early inflammatory reaction extending to the brainstem and resulting in edema and neurological deficits\u2014is rare, and optimal management strategies remain unclear.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 43-year-old man underwent MVD using two ball-shaped Teflon implants for vertebral artery transposition. Although his TN resolved immediately, he developed facial palsy and hearing disturbance on postoperative day 23. MRI showed marked FLAIR hyperintensity surrounding the Teflon adjacent to the brainstem without diffusion restriction, suggesting acute inflammation without evidence of infection. Prednisolone (20 mg\/day) was initiated, leading to rapid improvement of neurological symptoms and resolution of the edema. Glucocorticoids were gradually tapered and discontinued over 6 months, and no recurrence was observed during a 2-year follow-up period.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n Although surgical removal is generally recommended for symptomatic Teflon granuloma, early glucocorticoid therapy may be effective when acute inflammatory Teflon granuloma is suspected and infection has been carefully excluded.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE251023<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case251023","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T13:13:04Z","timestamp":1773925984000},"source":"Crossref","is-referenced-by-count":0,"title":["Early glucocorticoid therapy for brainstem edema associated with acute inflammatory Teflon granuloma after microvascular decompression for trigeminal neuralgia: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-3470-7745","authenticated-orcid":true,"given":"Kiichi","family":"Sakai","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryosuke","family":"Ogura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kouichirou","family":"Okamoto","sequence":"additional","affiliation":[{"name":"Department of Translational Research, Brain Research Institute, Niigata University, Niigata, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaoru","family":"Tomikawa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryota","family":"Okura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shisei","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daiju","family":"Mitsuhashi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tetsuya","family":"Hiraishi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Makoto","family":"Oishi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"3","key":"bib1","series-title":"Neurosurg Rev","first-page":"513","article-title":"Teflon granuloma after microvascular decompression for hemifacial spasm: a case report and literature review","volume":"40","author":"Oda","year":"2017","unstructured":"Oda KHiguchi TMurai YYamaguchi FMorita A.Teflon granuloma after microvascular decompression for hemifacial spasm: a case report and literature review. Neurosurg Rev. 2017;40(3):513-516. doi:10.1007\/s10143-017-0865-5"},{"issue":"5","key":"bib2","series-title":"Acta Neurochir (Wien)","first-page":"537","article-title":"Teflon granuloma with midbrain cysts after microvascular decompression of the trigeminal nerve","volume":"149","author":"Smucker","year":"2007","unstructured":"Smucker PBonnin JMPritz MB.Teflon granuloma with midbrain cysts after microvascular decompression of the trigeminal nerve. Acta Neurochir (Wien). 2007;149(5):537-539. doi:10.1007\/s00701-007-1136-y"},{"key":"bib3","series-title":"Neurosurgery","article-title":"Microvascular decompression for patients with Type 1 trigeminal neuralgia using vein sacrifice and a Teflon transposition technique: a 23-year cohort","author":"Kumar","year":"2025","unstructured":"Kumar RStien KJPollock BE.Microvascular decompression for patients with Type 1 trigeminal neuralgia using vein sacrifice and a Teflon transposition technique: a 23-year cohort. Neurosurgery. 2025. doi:10.1227\/neu.0000000000003614"},{"key":"bib4","series-title":"World Neurosurg","first-page":"e612","article-title":"Teflon granuloma: a common cause of recurrent trigeminal neuralgia","volume":"158","author":"Sun","year":"2022","unstructured":"Sun TWang WHuang QTeflon granuloma: a common cause of recurrent trigeminal neuralgia. World Neurosurg. 2022;158:e612-e617. doi:10.1016\/j.wneu.2021.11.033"},{"issue":"4","key":"bib5","series-title":"J Headache Pain","first-page":"339","article-title":"Treatment of recurrent trigeminal neuralgia due to Teflon granuloma","volume":"11","author":"Capelle","year":"2010","unstructured":"Capelle HHBrandis ATschan CAKrauss JK.Treatment of recurrent trigeminal neuralgia due to Teflon granuloma. J Headache Pain. 2010;11(4):339-344. doi:10.1007\/s10194-010-0213-4"},{"issue":"12","key":"bib6","series-title":"J Neurosurg Case Lessons","first-page":"CASE2318","article-title":"Preoperative three-dimensional multifusion imaging aiding successful microvascular decompression of a cerebellopontine angle lipoma: associated hemifacial spasm. Illustrative case","volume":"5","author":"Seto","year":"2023","unstructured":"Seto HOgura RHiraishi TPreoperative three-dimensional multifusion imaging aiding successful microvascular decompression of a cerebellopontine angle lipoma: associated hemifacial spasm. Illustrative case. J Neurosurg Case Lessons. 2023;5(12):CASE2318. doi:10.3171\/CASE2318"},{"issue":"1","key":"bib7","series-title":"Sci Rep","first-page":"11540","article-title":"Analysis of risk factors of intracranial infection after microvascular decompression","volume":"15","author":"Guo","year":"2025","unstructured":"Guo ZZhang XZhao B.Analysis of risk factors of intracranial infection after microvascular decompression. Sci Rep. 2025;15(1):11540. doi:10.1038\/s41598-025-96431-7"},{"issue":"3","key":"bib8","series-title":"J Neurosurg","first-page":"454","article-title":"Teflon-induced granuloma following treatment of trigeminal neuralgia by microvascular decompression. Report of two cases","volume":"87","author":"Premsagar","year":"1997","unstructured":"Premsagar ICMoss TCoakham HB.Teflon-induced granuloma following treatment of trigeminal neuralgia by microvascular decompression. Report of two cases. 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Laryngoscope. 2017;127(3):715-719. doi:10.1002\/lary.26126"},{"issue":"10","key":"bib13","series-title":"Ann R Coll Surg Engl","first-page":"e324","article-title":"Two cases of asymptomatic Teflon granulomas following microvascular decompression mimicking cerebellopontine angle tumours: lessons learnt in the neuro-oncology multidisciplinary team","volume":"103","author":"Rojas-Villabona","year":"2021","unstructured":"Rojas-Villabona AMagnaye LJenkins ASurash S.Two cases of asymptomatic Teflon granulomas following microvascular decompression mimicking cerebellopontine angle tumours: lessons learnt in the neuro-oncology multidisciplinary team. Ann R Coll Surg Engl. 2021;103(10):e324-e326. doi:10.1308\/rcsann.2021.0030"},{"issue":"1","key":"bib14","series-title":"J Neurosurg","first-page":"145","article-title":"Aseptic meningitis caused by Teflon implantation for microvascular decompression. 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