Acute Glaucoma Attack Following Microvascular Decompression Surgery for Trigeminal Neuralgia

Abstract

Microvascular decompression (MVD) is widely accepted as an effective surgical method to treat trigeminal neuralgia (TN), but the risks of morbidity and mortality must be considered. We experienced a case of acute angle-closure glaucoma attack following MVD for TN in an elderly patient, considered to be caused by lateral positioning during and after the surgery. A 79-year-old female underwent MVD for right TN in the left lateral decubitus position, and TN disappeared after the surgery. Postoperatively, the patient tended to maintain the left lateral decubitus position to prevent wound contact with the pillow, even after ambulation. Two days after the surgery, she complained of persistent left ocular pain with visual disturbance. The left pupil was dilated with only light perception, and the intraocular pressure (IOP) was 44 mmHg. Acute angle-closure glaucoma attack was diagnosed. After drip infusion of mannitol, emergent laser iridotomy was performed. The corrected visual acuity recovered with normalization of IOP (14 mmHg). The subsequent clinical course was uneventful and she was discharged from our hospital. The left lateral positioning during and after the surgery was considered to have contributed to increase IOP of the eye on the dependent side, which resulted in acute angle-closure glaucoma attack. The potential pathology is difficult to assess preoperatively, but patient management should always consider the increased possibility of this condition with age.

Keywords: complication; glaucoma; lateral decubitus position; microvascular decompression; trigeminal neuralgia.

Fig. 1.

Preoperative consecutive gradient echo magnetic resonance images suggesting contact between the anterior inferior cerebellar artery and the proximal root of the right trigeminal nerve (arrows in upper and middle).

Fig. 2.

Intraoperative photographs. Upper: The anterior inferior cerebellar artery is compressing the root of the right trigeminal nerve. Lower: The artery was transposed to the cerebellar surface direction with a Teflon sling (asterisks).

Fig. 3.

Slit photographs of the anterior segment of the eyes at the onset of angle-closure glaucoma. Upper: Right eye; very narrow space between the cornea and iris suggesting shallow anterior chamber. Lower: Left eye; dilated pupil with corneal edema. C: cornea, I: iris.

Fig. 4.

Slit photographs of the anterior segment of the eyes after application of mydriatic eye drops following implantation of intraocular lens showing improvement of visualization of the anterior chamber in both eyes. C: cornea, I: iris.