Early glucocorticoid therapy for brainstem edema associated with acute inflammatory Teflon granuloma after microvascular decompression for trigeminal neuralgia: illustrative case

BACKGROUND 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%–7.3% of MVD cases and can lead to recurrent TN. However, acute inflammatory Teflon granuloma—characterized by an early inflammatory reaction extending to the brainstem and resulting in edema and neurological deficits—is rare, and optimal management strategies remain unclear. OBSERVATIONS 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. LESSONS 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. https://thejns.org/doi/10.3171/CASE251023