Oculo-motility defects and treated trigeminal neuralgia

Abstract

Purpose: To report the ocular motility defects associated with the surgical treatment of trigeminal neuralgia. Methods: There were five patients who presented with ocular motility defects after surgical treatment of trigeminal neuralgia. In three patients the method of treatment was microvascular decompression (MVD) of the trigeminal ganglion. Two patients were treated with percutaneous controlled radiofrequency trigeminal rhizotomy (RF-TR). Results: There were four male patients. The mean age was 67.8 ± 9.1 years (median, 73years). In the three patients treated with MVD, two presented with fourth nerve palsy and one presented with sixth nerve palsy. All these patients made a complete recovery between 5 and 8 months. In the two patients treated with RF-TR one patient presented with a third nerve palsy that recovered completely over a 6 month period. The other patient presented with a complete third, fourth, and sixth nerve palsy. At the 7-month follow-up he continues to have a partially recovered third nerve palsy. Conclusions: The surgical treatment for trigeminal neuralgia may result in potentially serious ophthalmic side effects or complications. Ophthalmologists should be aware that ocular motor cranial neuropathies can occur after these procedures and that, although complete recovery is seen in the majority of cases, persisting palsies may also be encountered.