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Christopher David Weaver, Steven A Newman; Orbital Complications of Trans-Foramen Ovale Surgical Manipulation. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4450.
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Approach through the foramen ovale for pathology affecting the Gasserian rhizototomy ganglion has been standard practice for neurosurgery for more than 75 years. Procedures include glycerol rhizotomy and electro cautery disruption of the trigeminal nerve. Complications have been uncommon. It is, however, possible to enter the orbit through the inferior orbital fissure.
Two cases of patients seen following attempt at glycerol injection of the Gasserian ganglion developed intraorbital complications.
In one case an intraorbital hematoma led to transient diplopia with complete resolution without additional complications. In another case, the needle lacerated the ophthalmic artery, resulting in a pseudo-aneurysm which required neuro-interventional coiling. The motility improved, but the patient was left with a complete optic neuropathy.
Root cause analysis of these cases indicates that placement of the needle too far laterally in the cheek permits access to the inferior orbital fissure, which is otherwise protected by the lateral wall of the maxilla. Attention to anatomic detail with the possible use of neuro navigation should make these complications less frequent in the future.
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