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目的 探讨机器人辅助经皮球囊压迫术(PBC)治疗三叉神经痛的有效性及安全性。方法 回顾性分析2022年8月至2023年12月广西壮族自治区南溪山医院神经外科机器人辅助下PBC治疗的9例三叉神经痛患者的临床资料。术前行头颅薄层CT和MRI检查，影像数据导入机器人工作站行多模态影像融合，设计手术路径，靶点设在卵圆孔的内口，穿刺路径的延长线通过Meckel腔。机器人适配器引导下完成实际路径卵圆孔穿刺，在C型臂X线机侧位辅助下完成Meckel腔穿刺，充盈球囊至“梨形”。术前、术后即刻、术后6个月采用视觉模拟量表(VAS)评分评估疼痛程度，采用巴罗神经病学研究所(BNI)分级评估面部麻木程度。结果 9例均顺利完成机器人辅助下PBC，球囊充盈状态下呈现“梨形”。术前机器人摆放及3D结构光注册时间12.0～20.0(15.1±2.4) min，手术时间23.0～69.0(36.0±15.5)min，球囊充盈体积0.4～0.8(0.6±0.1)mL。术中球囊破裂1例。8例卵圆孔一次穿刺成功，1例反复穿刺3次。术后即刻9例疼痛症状均缓解，VAS评分由术前9～10分均降至0分。术后9例均出现面部麻木，BNI分级Ⅱ～Ⅲ级。1例术后即刻出现口唇疱疹，经抗病毒治疗疱疹消失。1例术后1个月出现咀嚼肌无力，但在术后3个月恢复。术后未出现视力下降、颅内感染。9例术后随访6个月，面部麻木均减轻，VAS评分均为0分。结论 机器人可以为PBC提供精准定位，有助于提高手术安全性，短期疗效满意。
Abstract：Objective To investigate the efficacy and safety of robotic-assisted percutaneous balloon compression(PBC) in the treatment of trigeminal neuralgia.Methods A retrospective analysis was conducted on the clinical data of 9 patients with trigeminal neuralgia who underwent robotic-assisted PBC in the Department of Neurosurgery,Nanxishan Hospital of Guangxi Zhuang Autonomous Region,from August 2022 to December 2023.Preoperative thin-slice head CT and MRI examinations were performed,and the imaging data were imported into the robotic workstation for multimodal image fusion.The surgical trajectory was designed with the target point set at the inner opening of the foramen ovale,and the extension line of the puncture trajectory passed through Meckel's cave.Puncture of the foramen ovale along the planned trajectory was performed under the guidance of a robotic adapter.Subsequently,puncture of the Meckel's cave was completed with the assistance of lateral fluoroscopy using a C-arm X-ray machine,and the balloon was inflated until a "pear-shaped" appearance was achieved.Pain levels were assessed using the Visual Analog Scale(VAS) preoperatively,immediately postoperatively,and at 6 months postoperatively.Facial numbness was evaluated using the B arrow Neurological Institute(BNI) scale.Results Robotic-assisted PB C was successfully completed in all 9 cases,with the balloon presenting a "pear shape" upon inflation.Preoperative robot positioning and 3D structured light registration took 12.0～20.0(15.1±2.4) min.The total operative time was 23.0～69.0(36.0± 15.5) min,and the balloon inflation volume was 0.4～0.8(0.6±0.1) mL.Intraoperative balloon rupture occurred in 1 case.Successful puncture of the foramen ovale on the first attempt was achieved in 8 cases,while 1 case required three puncture attempts.Immediate postoperative pain relief was achieved in all 9 cases,with VAS scores decreasing from 9～10 preoperatively to 0.All 9 patients experienced postoperative facial numbness,graded as BNI level Ⅱ～Ⅲ.One patient developed oral herpes immediately gery,which resolved with antiviral treatment.Another patient developed masticatory muscle weakness one month postoperatively,which recovered by three months postoperatively.No cases of visual impairment or intracranial infection occurred.At the 6-month follow-up,facial numbness had diminished in all 9 patients,and VAS scores remained 0.Conclusion Robotics can provide precise localization for PBC,potentially enhancing surgical safety,with satisfactory short-term efficacy.
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基本信息:
DOI：10.13798/j.issn.1009-153X.2026.03.002
中图分类号:TP242;R651.3
引用信息:
[1]彭志柱,陈慧溪,王文波,等.机器人辅助经皮球囊压迫术治疗三叉神经痛的效果[J].中国临床神经外科杂志,2026,31(03):135-139.DOI:10.13798/j.issn.1009-153X.2026.03.002.
基金信息:
广西医疗卫生适宜技术开发与推广应用项目（S2022028）
2026-03-25
2026-03-25