Urculo Enrique, Alfaro Roger, Arrazola Mariano, Astudillo Edgar, Rejas Guillermo
Department of Neurosurgery, Hospital Donostia, Paseo del Dr. Begiristain s/n, 20014 San Sebastian, Spain.
Neurosurgery. 2004 Feb;54(2):505-8; discussion 508-9. doi: 10.1227/01.neu.0000103675.32713.a9.
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.
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.
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.
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.
反复经皮气囊压迫治疗特发性三叉神经痛并不常见。当进行第二次手术时，其结果尚不清楚。一名患者在第二次接受经皮三叉神经节气囊压迫术后出现孤立性滑车神经麻痹。对复视的机制及与该技术相关的并发症进行了研究。
患者为一名67岁女性，有药物难治性特发性三叉神经痛病史，累及右侧三叉神经的所有三个分支。
进行了经皮气囊压迫。尽管最初疼痛完全缓解且无并发症，但患者在术后3个月再次出现三叉神经痛表现。在她接受第二次气囊压迫手术后疼痛消失，但她出现了孤立性滑车神经麻痹，2个月后自行缓解。
孤立性滑车神经麻痹是经皮气囊压迫治疗三叉神经痛后一种罕见且可逆的并发症。该病例表明，第四神经损伤的机制是技术失误：Fogarty导管在Meckel腔中过度穿透三叉神经孔，当膨胀的气囊推向小脑幕时压迫滑车神经的脑池段。
