{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T09:20:22Z","timestamp":1782552022017,"version":"3.54.5"},"reference-count":25,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2021,5,26]],"date-time":"2021-05-26T00:00:00Z","timestamp":1621987200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2021,5,12]]},"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Trigeminal neuralgia (TN) has the highest incidence of disorders causing facial pain. TN is provoked by benign stimuli, like shaving, leading to severe, short-lasting pain. Patients are initially treated using antiepileptic drugs; however, multiple invasive options are available when conservative treatment proves insufficient. Percutaneous radiofrequency treatment of the trigeminal, or gasserian, ganglion (RF-G) is a procedure regularly used in refractory patients with comorbidities. RF-G involves complex needle maneuvering to perform selective radiofrequency heat treatment of the affected divisions. We present a unique case of cranial nerve 4 (CN4) paralysis after RF-G.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case presentation<\/jats:title>\n                  <jats:p>A male patient in his 60s presented with sharp left-sided facial pain and was diagnosed with TN, attributed to the maxillary and mandibular divisions. MRI showed a vascular loop of the anterior inferior cerebellar artery without interference of the trigeminal complex. The patient opted for RF-G after inadequate conservative therapy. The procedure was performed by an experienced pain physician and guided by live fluoroscopy. The patient was discharged without problems but examined the following day for double vision. Postprocedural MRI showed enhanced signaling between the trigeminal complex and the brainstem. Palsy of CN4 was identified by a neurologist, and spontaneous recovery followed 5\u2009months after the procedure.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Mention of postprocedural diplopia in guidelines is brief, and the exact incidence remains unknown. Different mechanisms for cranial nerve (CN) palsy have been postulated: incorrect technique, anatomical variations, and secondary heat injury. We observed postprocedural hemorrhage and hypothesized that bleeding might be a contributing factor in injury of CNs after RF-G.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2020-102285","type":"journal-article","created":{"date-parts":[[2021,5,26]],"date-time":"2021-05-26T14:31:05Z","timestamp":1622039465000},"page":"1002-1005","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Percutaneous radiofrequency treatment of the gasserian ganglion for trigeminal neuralgia complicated by trochlear nerve palsy: a case report"],"prefix":"10.1136","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8433-2050","authenticated-orcid":false,"given":"Pascal SH","family":"Smulders","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Amsterdam UMC location AMC, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel AMB","family":"Terheggen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Rijnstate, Arnhem, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7043-968X","authenticated-orcid":false,"given":"Jos\u00e9 W","family":"Geurts","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Rijnstate, Arnhem, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan Willem","family":"Kallewaard","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Amsterdam UMC location AMC, Amsterdam, The Netherlands"},{"name":"Department of Anesthesiology and Pain Medicine, Rijnstate, Arnhem, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,5,26]]},"reference":[{"key":"2025101112332800000_46.11.1002.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2009.08.023"},{"key":"2025101112332800000_46.11.1002.2","unstructured":"Headache Classification Committee of the International Headache Society (IHS) . 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