Trochlear Nerve Palsy after Repeated Percutaneous Balloon Compression for Recurrent Trigeminal Neuralgia: Case Report and Pathogenic Considerations

Neurosurgery ◽  
2004 ◽  
Vol 54 (2) ◽  
pp. 505-509 ◽  
Author(s):  
Enrique Urculo ◽  
Roger Alfaro ◽  
Mariano Arrazola ◽  
Edgar Astudillo ◽  
Guillermo Rejas
Keyword(s):  
Trigeminal Neuralgia ◽  
Nerve Palsy ◽  
Fogarty Catheter ◽  
Trochlear Nerve ◽  
Inflated Balloon ◽  
Balloon Compression ◽  
Percutaneous Balloon ◽  
Idiopathic Trigeminal Neuralgia ◽  
Percutaneous Balloon Compression ◽  
Trochlear Nerve Palsy

Abstract OBJECTIVE AND IMPORTANCE Repeated percutaneous balloon compression for the treatment of idiopathic trigeminal neuralgia is infrequent. When a second procedure is performed, the outcome is unknown. A patient developed an isolated trochlear nerve palsy after undergoing percutaneous trigeminal ganglion balloon compression for a second time. The mechanism of diplopia and the complications associated with this technique were studied. CLINICAL PRESENTATION The patient was a 67-year-old woman with a history of medically refractory idiopathic trigeminal neuralgia involving all three divisions of the right trigeminal nerve. INTERVENTION Percutaneous balloon compression was performed. Despite initial total relief from pain without complications, the patient again displayed manifestations of trigeminal neuralgia 3 months after the procedure. The pain disappeared after she underwent a second balloon compression procedure, but she developed an isolated trochlear nerve palsy, which spontaneously resolved in 2 months. CONCLUSION Isolated trochlear nerve palsy is a rare and reversible complication after percutaneous balloon compression for trigeminal neuralgia. This case illustrates that the mechanism of injury to the fourth nerve is the result of an erroneous technique: excessive penetration of the Fogarty catheter in Meckel's cave beyond the porus trigemini and compression of the cisternal segment of the trochlear nerve when the inflated balloon is pushed against the tentorium.

scholarly journals The Transformation of the Balloon Shape in Percutaneous Balloon Compression for Trigeminal Neuralgia

2021 ◽  
Author(s):  
Chenglong Sun ◽  
Wenhua Yu ◽  
Qiang Zhu ◽  
Quan Du
Keyword(s):  
Trigeminal Neuralgia ◽  
Therapeutic Effect ◽  
Gold Standard ◽  
Inflated Balloon ◽  
Surgical Result ◽  
Balloon Compression ◽  
Percutaneous Balloon ◽  
Percutaneous Balloon Compression ◽  
Anatomic Basis ◽  
Shape Changes

Abstract Background: The pear shape of an inflated balloon is thought to be a gold standard of a successful percutaneous balloon compression (PBC). However, neither how the balloon shape changes nor why it changes in that way (the anatomic basis) has not yet been fully described. Methods: Radiographs from over 150 percutaneous balloon compression (PBC) cases were thoroughly evaluated. We proposed a model of changing balloon shape in Meckel's cave (MC) and 70 cases were followed up over 2 years, in which therapeutic effect was measured.Results: We found that the balloon changed stereotypically in MC. The model that we proposed is consistent with the description of the structures of MC and its surroundings in the literature. The distinct pear (pear in MC) brought about a far better surgical result than other shapes (p < 0.01).Conclusion: Our study showed how and why the balloon shape changed during PBC surgery. The model provides favorable guidance for PBC surgery.

scholarly journals Percutaneous balloon compression of Gasserian ganglion for idiopathic trigeminal neuralgia

2019 ◽  
Vol 33 (3) ◽  
pp. 136
Author(s):  
Anurag Agarwal ◽  
Shivani Rastogi ◽  
Manjari Bansal ◽  
Hitesh Patel ◽  
Deepak Malviya ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Gasserian Ganglion ◽  
Balloon Compression ◽  
Percutaneous Balloon ◽  
Idiopathic Trigeminal Neuralgia ◽  
Percutaneous Balloon Compression

scholarly journals Comparison of Effectiveness and Safety between Intraoperative 3D-CT-Guided and C-Arm-Guided Percutaneous Balloon Compression for Idiopathic Trigeminal Neuralgia:  A  Multi-Center Retrospective Study

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Xiong Xiao ◽  
Zhengjun Wei ◽  
Hao Ren ◽  
Hongtao Sun ◽  
Fang Luo
Keyword(s):  
Trigeminal Neuralgia ◽  
Medical Center ◽  
3D Ct ◽  
Ct Guided ◽  
Balloon Compression ◽  
Needle Pass ◽  
Percutaneous Balloon ◽  
Idiopathic Trigeminal Neuralgia ◽  
Percutaneous Balloon Compression ◽  
Comparison Of Effectiveness

Objectives. To compare 3D-CT-guided and C-arm-guided percutaneous balloon compression (PBC) in terms of effectiveness and safety. Methods. The medical records and follow-up data of patients with idiopathic trigeminal neuralgia who underwent 3D-CT-guided or C-arm-guided PBCs in Beijing Tiantan Hospital and the Characteristic Medical Center of the Chinese People’s Armed Police Force between February 2018 and March 2020 were retrospectively reviewed and analysed. Results. A total of 291 patients were included. Among them, 212 patients underwent PBC treatment with 3D-CT and others with C-arm. One (0.5%) patient in 3D-CT group and 4 (5.1%) patients in C-arm group failed to receive PBC treatment because of failure of foramen ovale (FO) puncture ( P = 0.020 ). Among patients with successful attempts, 5 (2.4%) patients in the 3D-CT group and 11 (14.7%) patients in the C-arm group received more than one needle pass during the procedure ( P < 0.001 ). The 3D-CT group required less time than the C-arm group for puncture ( P < 0.001 ) and for the whole operation ( P < 0.001 ). The groups shared similar initial relief rates ( P = 0.749 ) and similar recurrence-free survival during follow-ups for a median of 22 months ( P = 0.839 ). No puncture-related complications occurred in either group and the two groups had similar incidences of compression-related complications. Conclusion. 3D-CT facilitated FO puncture and improved success rate of PBC. The overall time efficiency of PBC was also increased with 3D-CT. Thus, 3D-CT is a potentially useful image guidance technology for treating idiopathic trigeminal neuralgia by PBC.

scholarly journals A prospective study of 39 patients with trigeminal neuralgia treated with percutaneous balloon compression

2011 ◽  
Vol 69 (2a) ◽  
pp. 221-226 ◽  
Author(s):  
Wuilker Knoner Campos ◽  
Marcelo N. Linhares
Keyword(s):  
Trigeminal Neuralgia ◽  
Female Gender ◽  
Safe Procedure ◽  
Approval Ratings ◽  
Balloon Compression ◽  
Percutaneous Balloon ◽  
Percutaneous Balloon Compression ◽  
The Face ◽  
The Right ◽  
A Prospective Study

OBJECTIVE: Trigeminal neuralgia is the most common facial pain. It may be treated with percutaneous balloon compression (PBC), which is considered to be a safe and efficient procedure. The purpose of this study was to review our results with PBC and to assess the factors influencing the outcome. METHOD: A multivariate analysis was used to study 39 patients during a 50-month postoperative period. RESULTS: There was predominance of the female gender (54%), the right side of the face (84%) and V2V3 roots of trigeminal nerve (33%). The mean age was 62.3 years. No major complications or deaths occurred. Among all variables, postoperative hypoesthesia was the single prognostic factor capable of positively influencing the results (p=0.02). Most patients (80%) were pain-free after 50 months with a 90% satisfaction rate. CONCLUSION: PBC was a safe procedure with low morbidity, no mortality, high approval ratings, and was an important improving on patients' quality of life.

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