Abducent nerve palsy after microballoon compression of the trigeminal ganglion: Case report

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Abstract

Background:

Trigeminal neuralgia (TN) is the most common type of facial neuralgia with incidence of 26.8/100,000 person year. In general, this scenario is characterized by a lancinating, unilateral, paroxysmal pain in the area of the fifth cranial nerve. Several treatment methods, including the injection of ethyl alcohol or butyl alcohol into the ganglion, the glycerol injection into the trigeminal cistern, peripheral nerve divisions, the radiofrequency thermocoagulation of the preganglionic fibers, and radiosurgery has been used for TN.

Case Description:

A case of a 74-year-old woman patient who undergone a treatment of TN through a compression of Meckel cave and developed a transient abducent palsy is presented. Complication regarding to a palsy of abducent nerve is discussed as well as the analysis of presumable evolving physiopathology. A critical review of literature was performed.

Conclusions:

Among the procedures, we mean that percutaneous microballoon compression (PMC) is the best choice for elderly frail patients, because it had a very low associated mortality-morbidity rate and does not damage permanent the Gasserian ganglion.

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Most cited references 28

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Percutaneous microcompression of the trigeminal ganglion for trigeminal neuralgia.

S Mullan, T Lichtor (1983)

Fifty patients were treated for trigeminal neuralgia by percutaneous microcompression of the trigeminal ganglion. A No. 4 Fogarty balloon catheter was inserted under brief general anesthesia, using biplane fluoroscopy. This procedure is essentially a percutaneous simplication of the older Taarnhøj-Sheldon-Pudenz operation. The follow-up period ranged from 0.5 to 4.5 years. Pain recurred in 12% of cases during that time, and it is anticipated that within 5 years the recurrence rate will reach 20%, which is approximately the same rate as for the alternative established procedures. The advantages of this technique are freedom from discomfort on the part of the patient, a remarkable ease of performance on the part of the operator, absence of associated mortality, and a minimal morbidity rate.

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Pathophysiology of trigeminal neuralgia: the ignition hypothesis.

Marshall Devor, Ron Amir, Z Rappaport (2015)

There are no satisfactory animal models of trigeminal neuralgia, and it is difficult to obtain essential data from patients. However, trigeminal neuralgia presents with such idiosyncratic signs and symptoms, and responds to so distinctive a set of therapeutic modalities, that scientific deduction can be used to generate likely hypotheses. The ignition hypothesis of trigeminal neuralgia is based on recent advances in the understanding of abnormal electrical behavior in injured sensory neurons, and new histopathologic observations of biopsy specimens from patients with trigeminal neuralgia who are undergoing microvascular decompression surgery. According to the hypothesis, trigeminal neuralgia results from specific abnormalities of trigeminal afferent neurons in the trigeminal root or ganglion. Injury renders axons and axotomized somata hyperexcitable. The hyperexcitable afferents, in turn, give rise to pain paroxysms as a result of synchronized afterdischarge activity. The ignition hypothesis accounts for the major positive and negative signs and symptoms of trigeminal neuralgia, for its pathogenesis, and for the efficacy of treatment modalities. Proof, however, awaits the availability of key experimental data that can only be obtained from patients with trigeminal neuralgia.

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Systematic review of ablative neurosurgical techniques for the treatment of trigeminal neuralgia.

Benjamin Lopez, Peter J Hamlyn, Joanna M Zakrzewska (2004)

There are no randomized controlled trials comparing retrogasserian percutaneous radiofrequency thermocoagulation, glycerol rhizolysis, balloon compression of the gasserian ganglion, and stereotactic radiosurgery, nor are there systematic reviews using predefined quality criteria. The objective of this study was to systematically identify all of the studies reporting outcomes and complications of ablative techniques for treatment of trigeminal neuralgia, from the development of electronic databases, and to evaluate them with predefined quality criteria. Inclusion criteria for the outcome analysis included thorough demographic documentation, defined diagnostic and outcome criteria, a minimum of 30 patients treated and median/mean follow-up times of 12 months, not more than 20% of patients lost to follow-up monitoring, Kaplan-Meier actuarial analysis of individual procedures, less than 10% of patients retreated because of failure or early recurrence, and a minimal dose of 70 Gy for stereotactic radiosurgery. High-quality studies with no actuarial analysis were used for the evaluation of complications. Of 175 studies identified, 9 could be used to evaluate rates of complete pain relief on a yearly basis and 22 could be used to evaluate complications. In mixed series, radiofrequency thermocoagulation offered higher rates of complete pain relief, compared with glycerol rhizolysis and stereotactic radiosurgery, although it demonstrated the greatest number of complications. Radiofrequency thermocoagulation offers the highest rates of complete pain relief, although further data on balloon microcompression are required. It is essential that uniform outcome measures and actuarial methods be universally adopted for the reporting of surgical results. Randomized controlled trials are required to reliably evaluate new surgical techniques.

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Author and article information

Contributors

Cassiano Marchi

Paulo Henrique Pires de Aguiar

Ana Maria Moura

Giovanna Matricardi

Carolina Utsunomya Muniz

Rogério Aires

Flávia Gehrke

Natally Santiago

Samuel Simis

Journal

Journal ID (nlm-ta): Surg Neurol Int

Journal ID (iso-abbrev): Surg Neurol Int

Journal ID (publisher-id): SNI

Title: Surgical Neurology International

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 2229-5097

ISSN (Electronic): 2152-7806

Publication date Collection: 2017

Publication date (Electronic): 21 June 2017

Volume: 8

Electronic Location Identifier: 125

Affiliations

[1 ]Department of Neurosurgery, Hospital Santa Paula, São Paulo, Brazil

[2 ]Department of Surgery, Post Graduation Section, Federal University of Rio Grande do Sul, São Paulo, Brazil

[3 ]Department of Medicine, Division of Neurology, Catholic Pontifical University of São Paulo, São Paulo, Brazil

[4 ]Section of Post Graduation of IAMSPE, São Paulo State Civil Servant Hospital, São Paulo, Brazil

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[* ]Corresponding author

Article

Publisher ID: SNI-8-125

DOI: 10.4103/sni.sni_375_16

PMC ID: 5502296

PubMed ID: 28713629

SO-VID: 77f9a68d-aa8b-49ec-a14e-52081a4b8971

License:

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Abducent nerve palsy after microballoon compression of the trigeminal ganglion: Case report

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Abstract

Background:

Case Description:

Conclusions:

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ScienceOpen Clinical Case Reports Collection

Most cited references 28

Percutaneous microcompression of the trigeminal ganglion for trigeminal neuralgia.

Pathophysiology of trigeminal neuralgia: the ignition hypothesis.

Systematic review of ablative neurosurgical techniques for the treatment of trigeminal neuralgia.

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