“四步法”机器人引导经皮三叉神经半月节球囊压迫术  

Application of“Four-step”Method in Robot-guided Percutaneous Balloon Compression of the Gasserian Ganglion for Trigeminal Neuralgia

作　　者：司雨[1] 吴超[1] 陈素华 林国中[1] 韩芸峰[1] 杨军 马长城[1] Si Yu;Wu Chao;Chen Suhua(Department of Neurosurgery,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院神经外科,北京100191

出　　处：《中国微创外科杂志》2022年第12期929-933,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的总结“四步法”机器人引导下经皮三叉神经半月节球囊压迫术的效果。方法回顾性分析2020年6月~2021年11月20例三叉神经痛行机器人引导下经皮三叉神经半月节球囊压迫术的资料。术前疼痛视觉模拟评分(Visual Analogue Scale,VAS)中位数8分(7~10分)。以“四步法”操作流程实施术前规划和手术:①在三维图像上初步定位;②在CT矢状位和冠状位图像上确定穿刺方向;③在MRI图像上微调穿刺路径和Meckel囊的关系;④低阻力穿刺。结果20例均顺利完成手术,术中X线侧位片球囊均呈现典型“梨形”形态。术后即刻疼痛症状均缓解,VAS评分0分17例,1分3例。术后均术侧面部麻木、术侧一半舌体深浅感觉障碍,15例术侧咀嚼肌肌力下降,1例术侧角膜反射减退,3例术后口角疱疹。术后随访3~23(10.7±5.1)月,VAS评分均为0分,无三叉神经痛复发。2例残留面部轻微麻木,余18例术后面部麻木、舌体感觉障碍、咀嚼肌无力、角膜反射减退和口角疱疹均消失。结论采用“四步法”实施机器人引导下经皮三叉神经半月节球囊压迫术疗效满意。Objective To summarize the effect of“four-step”method in robot-guided percutaneous balloon compression of the gasserian ganglion for trigeminal neuralgia.Methods Clinical data of 20 patients with trigeminal neuralgia who underwent robot-guided percutaneous balloon compression of the gasserian ganglion from June 2020 to November 2021 were retrospectively analyzed.The median Visual Analogue Scale(VAS)score of the 20 patients before surgery was 8(range,7-10).Preoperative planning and surgery were performed with a“four-step”process:①preliminary positioning on three-dimensional images;②determination of puncture direction on sagittal and coronal CT images;③fine-tuning of the relationship between puncture path and Meckel’s sac on MRI images;and④low-resistance puncture.Results All the patients successfully received the operation,and the intraoperative lateral X-ray balloon showed a typical“pear shape”.The pain symptoms were relieved immediately after operation,with the VAS scores being 0 in 17 cases and 1 in 3 cases.Postoperative operation-sided numbness with unilateral sensory dysfunction of half of the tongue were observed in all the patients,masticatory muscle strength decreased in 15 patients,corneal reflex decreased in 1 patient,and oral herpes occurred in 3 patients.The patients were followed up for 3-23 months(mean,10.7±5.1 months).The VAS score was 0 in all the patients,and no trigeminal neuralgia recurred.Residual mild facial numbness was found in 2 cases,while facial numbness,lingual dysesthesia,masticatory muscle weakness,hypocorneal reflexes and oral herpes disappeared in the other 18 cases.Conclusion Using the“four-step”method to implement the robot-guided percutaneous balloon compression of the gasserian ganglion has satisfactory results.

关 键 词：机器人引导 三叉神经痛 球囊压迫 

分 类 号：R651.3[医药卫生—外科学]