Document Detail


Sudden blindness as a complication of percutaneous trigeminal procedures: mechanism analysis and prevention.
MedLine Citation:
PMID:  18928354     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The authors describe the case of a 76-year-old man in whom reversible sudden blindness developed after a percutaneous balloon compression rhizotomy for trigeminal neuralgia. His eye became tense and swollen with intraocular pressures of 66 mm Hg. Acetazolamide was administered, and visual acuity (20/50) returned within several months. Despite correct needle placement, the intraocular pressure rose acutely because of transient occlusion of the orbital venous drainage through the cavernous sinus; this was reversed with aggressive medical treatment. In cadaveric studies (dried skull and formalin-fixed head), the authors studied the mechanism of optic nerve penetration. Their findings showed that excessive cranial angulation of the needle with penetration of the inferior orbital fissure can directly traumatize the optic nerve in the orbital apex. Direct trauma to the optic nerve can therefore be prevented by early and repeated confirmation of the needle trajectory with lateral fluoroscopy before penetration of the foramen ovale.
Authors:
Siviero Agazzi; Stanley Chang; Mitchell D Drucker; A Samy Youssef; Harry R Van Loveren
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  110     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-04-02     Completed Date:  2009-05-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  638-41     Citation Subset:  AIM; IM    
Affiliation:
Department of Neurosurgery, University of South Florida, Tampa, Florida 33606, USA. sagazzi@hsc.usf.edu
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MeSH Terms
Descriptor/Qualifier:
Acetazolamide / therapeutic use
Aged
Blindness / etiology*
Cadaver
Humans
Intraocular Pressure
Male
Optic Nerve Injuries / prevention & control
Postoperative Complications
Rhizotomy / methods*
Trigeminal Nerve / surgery*
Trigeminal Neuralgia / surgery*
Visual Acuity / drug effects
Chemical
Reg. No./Substance:
59-66-5/Acetazolamide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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