机器人辅助经皮球囊压迫术治疗三叉神经痛的临床分析  

Clinical analysis of robot-assisted percutaneous balloon compression for the treatment of trigeminal neuralgia

作　　者：马峻[1] 李勇刚[1] 陈心[1] 雪亮[1] 苏少波[1] 岳树源[1] Ma Jun;Li Yonggang;Chen Xin;Xue Liang;Su Shaobo;Yue Shuyuan(Department of Neurosurgery,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院神经外科,300052

出　　处：《中华神经外科杂志》2021年第9期894-898,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨神经外科手术导航定位计划系统(简称机器人)辅助经皮球囊压迫术治疗三叉神经痛的临床效果。方法回顾性分析2020年3-11月天津医科大学总医院神经外科采用机器人辅助经皮球囊压迫术治疗13例三叉神经痛患者的临床资料。患者术前均行头颅CT和三维时间飞跃法磁共振血管成像检查,之后利用机器人进行多模态图像融合三维重建、载人术前计划和实施经皮球囊压迫术。患者手术前、后的疼痛程度采用视觉模拟评分法(VAS)评估,并在术后1、3、6个月随访患者的预后情况。结果13例患者的机器人辅助经皮球囊压迫术均顺利完成,术后三叉神经痛均即刻得到缓解,VAS评分的中位数由10分(9~10分)均降至0分。患者术后均未出现血管损伤、复视、溃疡性角膜炎、感染并发症,但患者术后均出现手术同侧面部麻木症状。13例患者的随访时间为1~6个月,其中2例患者于术后3个月随访时面部麻木症状有所减轻;1例患者在术后1个月时出现手术侧咀嚼无力症状,6个月随访时其症状有所减轻。末次随访显示,13例患者的VAS疼痛评分仍为0分,均无疼痛复发现象。结论机器人辅助经皮球囊压迫术依托于导航机械臂引导可精准穿刺卵圆孔,准确置入球囊,有助于提高手术的安全性,减少术后并发症,短期随访疗效满意。Objective To investigate the clinical application of percutaneous balloon compression(PBC)assisted by a neurosurgical navigation and positioning planning system(referred to as robot)for the treatment of trigeminal neuralgia.Methods A retrospective analysis was conducted on the clinical data of 13 patients with trigeminal neuralgia treated with robot-assisted PBC at the Department of Neurosurgery,General Hospital of Tianjin Medical University from March 2020 to November 2020.Preoperatively,all subjects underwent computed tomography(CT)and three-dimensional time-of-flight magnetic resonance angiography(3D-TOF-MRA).The surgical navigation and positioning planning system was used for multimodal image fusion and 3D reconstruction,loading of preoperative plan,and PBC surgery.The VAS(visual analogue scale)was used to assess the patient's severity of pain before and after surgery,and the outcome was followed up at 1 month,3 months and 6 months after surgery.Results All 13 patients underwent robot-assisted PBC successfully and achieved immediate postoperative relief of trigeminal neuralgia.Their median VAS scores decreased from 10(9-10)to 0.None of the patients experienced complications such as vascular injury,diplopia,ulcerative keratitis,and infection,while all reported postoperative numbness on the ipsilateral face.Two patients showed relief of facial numbness at 3-month follow-up.One patient presented with masticatory weakness on the surgical side at 1 month post operation,which was relieved at 6-month follow-up.At the final follow-up,the VAS score remained 0 in 13 patients,and there was no recurrence of pain in any of the patients.Conclusion Robot-assisted PBC surgery relies on navigation and robotic arm guidance for precise puncture of the foramen ovale and accurate placement of the balloon,which help improve the safety of surgery and reduce postoperative complications.Short-term follow-up reveals satisfactory results.

关 键 词：三叉神经痛 机器人 经皮球囊压迫术 卵圆孔 治疗结果 

分 类 号：R651.3[医药卫生—外科学]