机器人辅助经皮球囊压迫术治疗老年人三叉神经痛

Robot-assisted percutaneous balloon compression for the treatment of trigeminal neuralgia in elderly patients

目的探讨机器人手术导航定位计划系统辅助完成老年人三叉神经痛经皮球囊压迫术的临床效果。方法回顾性分析首都医科大学附属北京朝阳医院神经外科2021年8月至2022年8月收治的11例老年三叉神经痛患者,术前行三维时间飞跃法磁共振血管成像、磁共振三维可变反转角快速自旋回波序列、薄层CT扫描,应用机器人工作站多模态影像融合,计算麦氏囊体积。手术规划设置两条路径:实际穿刺路径,靶点为卵圆孔内口前内象限;测量用虚拟路径,用于规划球囊置入深度。机械臂适配器引导下完成实际穿刺路径卵圆孔穿刺,数字减影血管造影机侧位X线透视下完成测量用虚拟路径,将球囊置入预定深度,充盈球囊至梨形完成手术。术前采用疼痛视觉模拟评分(VAS),术后采用巴罗神经病学研究所(BNI)分级评估面部麻木程度,术后随访1~12个月并对结果进行分析。结果11例患者均顺利穿刺卵圆孔并进入麦氏囊,球囊充盈呈梨型。10例(90.9%)患者术后即刻完全缓解,1例术后第5天延迟愈合。无手术相关严重并发症;随访患者均无疼痛复发,BNI麻木分级2~3分。球囊充盈体积与术前测量麦氏囊体积适宜的比值大致为1.7。结论机器人手术导航定位计划系统辅助完成三叉神经痛经皮球囊压迫术后和短期随访结果均表明在老年人患者中安全、有效。

Objective To investigate the clinical efficacy of trigeminal neuralgia treatment in elderly patients with percutaneous balloon compression assisted by a robotic surgical navigation and positioning planning system.MethodsEleven elderly patients with trigeminal neuralgia admitted to the Department of Neurosurgery,Beijing Chaoyang Hospital,Capital Medical University between August 2021 and August 2022 were retrospectively analyzed.Three-dimensional time-of-flight magnetic resonance angiography,a three-dimensional fast spin-echo sequence with variable flip angles and thin-slice CT scans were performed before the procedure,and multimodal image fusion was performed by a robot workstation.The volume of Meckel's cave was calculated.Two paths were set up in the surgical planning:an actual puncture path,targeting the anterior inner quadrant of the internal foramen ovale,and a virtual path,used to plan the insertion depth of the balloon.The actual puncture path was completed under the guidance of the robotic arm adapter,and the virtual path for depth measurement was completed under lateral X-ray views of digital subtraction angiography.The balloon was placed at the predetermined depth and was inflated to form a pear shape to complete the procedure.The visual analogue scale(VAS)score was used to evaluate preoperative pain,and the Barrow Neurological Institute(BNI)facial numbness score was used to evaluate postoperative facial numbness.The patients were followed up for 1-12 months and the results were analyzed.ResultsIn all of the 11 patients,puncturing the foramen ovale and entry into the Meckel's cave were successfully conducted and the balloon was inflated to form a pear shape.Ten patients(90.9%)achieved complete remission immediately after the procedure,and 1 patient had delayed healing at 5 days after the procedure.There were no serious complications related to the procedure.There was no recurrence of pain during the follow-up,and the BNI numbness grading was between 2-3.The ratio between the inflated balloon volume and the preoperative volume of the Meckel's cave was approximately 1.7.ConclusionsRobot-assisted percutaneous balloon compression is safe and effective for the treatment of trigeminal neuralgia in elderly patients.