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

Abstract

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.

Percutaneous Balloon Compression of Trigeminal Ganglion for the Treatment of Idiopathic Trigeminal Neuralgia : Experience in 50 Patients

“…All procedures share risk of complications and surgical results in these cases are related to needle placement, catheter location, balloon shape, and the compression time of the balloon 6,7,10) . Most of the surgical complications in this study, such as severe dysesthesia 6) , early failures 7) , and diplopia 11) could be also related to avoidable technical errors. Unlike other percutaneous procedures, the needle should not pass through the foramen ovale 4,9) .…”

Dyna-CT-assisted percutaneous microballoon compression for trigeminal neuralgia

“…However, percutaneous balloon compression has been reported to be complicated by hypesthesia, dysesthesia, masseter muscle weakness, anesthesia dolorosa, corneal anesthesia, absent corneal reflex, aseptic meningitis, transient sixth nerve palsy, otalgia and trochlear nerve palsy 6 8 10 11. Because of these complications, some have tried to measure the balloon pressure to avoid these problems 8.…”

Dyna-CT as an Imaging Adjunct to Routine Percutaneous Balloon Compression for Trigeminal Neuralgia

“…Van Gompel /Kallmes /Morris / Fode-Thomas /Atkinson Percutaneous balloon compression has been reported to be complicated by hypesthesia, dysesthesia, masseter muscle weakness, anesthesia dolorosa, corneal anesthesia, absent corneal reflex, aseptic meningitis, transient sixth nerve palsy, otalgia or trochlear nerve palsy [3,4,12,13] . Currently, beyond 2D imaging and measurement of the manual balloon compression, there is no way to correlate procedural occurances with postprocedural outcomes and complications [4] .…”