Trigeminal neuralgia is a known symptom of the tumors and aberrant vessels near 
the trigeminal nerve and the tentorial notch. There are very few reports of 
delayed development of trigeminal neuralgia after radiosurgical treatment of a 
tumor in these areas. This is a case report of a patient treated with 
radiosurgery for radiation induced meningiomas, 30 years after childhood whole 
brain radiation. The largest tumor was adjacent to the pons and left trigeminal 
nerve but did not cause any direct neurologic symptoms or facial pain. Nine 
months after radiosurgical treatment of the tumors, the patient developed left 
sided typical trigeminal facial pain and magnetic resonance imaging (MRI) 
demonstrated the marked reduction in the tumor size. The patient was 
subsequently treated with radiosurgery to the Gasserian ganglion with a 
resolution of facial pain. This article reviews the unique characteristics and 
unusual response to the radiation induced meningiomas to radiosurgery. This is a 
case of rapid shrinkage of the tumor seen on follow-up MRI scans, concurrent 
with the development of facial pain, suggests that the rapid shrinkage led to 
traction on adhesions and related microvasculature changes adjacent to the tumor 
and trigeminal nerve roots causing the subsequent trigeminal neuralgia.