Subacute vision loss after microvascular decompression for trigeminal neuralgia

Area of Science:

• Neurosurgery
• Ophthalmology
• Vascular Surgery

Background:

• Microvascular decompression (MVD) is the primary surgical treatment for medically refractory trigeminal neuralgia (TN).
• While MVD is generally safe, potential complications require ongoing investigation.
• Delayed visual complications post-MVD are exceptionally rare.

Observation:

• A patient experienced delayed visual loss and papilledema following MVD for TN.
• The visual disturbances were attributed to transverse sinus stenosis.
• The stenosis resulted from bone wax compression during the retrosigmoid craniotomy.

Findings:

• Bone wax used during retrosigmoid craniotomy can inadvertently compress the transverse sinus.
• This compression can lead to venous sinus stenosis and subsequent intracranial hypertension.
• Delayed visual loss and papilledema are potential sequelae of such venous compromise.

Implications:

• Meticulous attention is crucial during MVD to prevent iatrogenic venous sinus stenosis.
• Neurosurgeons must ensure bone wax placement does not obstruct venous drainage.
• Awareness of this rare complication is vital for timely diagnosis and management of visual disturbances after MVD.