Autopsy, 3D MRI and histopathological findings are presented in a patient who had suffered from trigeminal neuralgia and was treated two times by radiosurgery. The first treatment was performed with 90 Gy at the distal part of the nerve. Because of recurrent pain, a second irradiation was carried out delivering 70 Gy at a more proximal segment of the nerve 10 months later. The patient died from a hemorrhagic stroke 26 days following the second intervention. Autopsy revealed a neurovascular conflict close to the second radiosurgery shot. Histopathology demonstrated acute and chronic stage radiation-induced lesions in the trigeminal nerve.