Combined autonomic and cranial neuropathy following radiofrequency ablation for trigeminal neuralgia

To review the literature on neuro-ophthalmologic complications associated with radiofrequency ablation (RFA) for trigeminal neuralgia (TN) and, in light of current evidence, to present and analyze a case of combined autonomic and cranial neuropathy following the procedure.

A narrative literature review was conducted on neuro-ophthalmologic complications associated with RFA for TN. Published reports were analyzed with attention to involved cranial nerves, mechanisms of injury, clinical presentation, management strategies, and visual outcomes. In addition, a single case was retrospectively reviewed based on medical records, including clinical findings, neuro-ophthalmologic examination data, treatment interventions, and follow-up documentation. Data were synthesized in the context of existing literature.

Published literature indicates that neuro-ophthalmologic complications after RFA for TN are rare but may occur due to the proximity of the trigeminal ganglion to adjacent cranial and autonomic structures. Most reported cases involve isolated cranial nerve deficits, whereas simultaneous multiple nerves and sympathetic involvement is uncommon. In the present case, a 66-year-old female developed diplopia, corneal anesthesia, and anisocoria following RFA. Neuro-ophthalmologic evaluation demonstrated right trochlear nerve palsy, ophthalmic nerve (V1) dysfunction, and sympathetic involvement. Conservative management was initiated. During follow-up, ophthalmic nerve dysfunction resolved by week five, while full recovery of trochlear and sympathetic dysfunction occurred by month five.

Radiofrequency ablation for TN is generally safe but may rarely cause neuro-ophthalmologic complications due to proximity of cranial and autonomic structures. Early recognition and ophthalmologic follow-up are essential. This case highlights rare combined trochlear, ophthalmic, and sympathetic involvement after RFA.