Robot-Assisted Percutaneous Balloon Compression in Elderly Patients with Trigeminal Neuralgia

Abstract

Objective

To investigate the clinical effects of percutaneous balloon compression (PBC) for trigeminal neuralgia in elderly patients with the assistance of a neurosurgical navigation and positioning planning system (referred to hereafter as the robot).

Methods

We performed a retrospective analysis of 11 patients with trigeminal neuralgia. Preoperative TOF MRA, T2WI-SPACE, and thin-slice CT scans were performed, and the volume of Meckel’s Cave was calculated by multi-modal image fusion on a workstation. Surgical planning involved two paths. Path A was the actual puncture path, the target point was the anterior inner quadrant of the inner opening of the foramen ovale; Path B represented a virtual path for measurement, and was used to plan the depth of balloon placement. The foramen ovale puncture for path A was completed under the guidance of a robotic arm adapter, while path B was completed under lateral X-ray fluoroscopy with a DSA machine. The balloon was placed at a predetermined depth, and filled to a “pear” shape to complete the operation. Preliminary follow-up results were obtained by considering VAS score and BNI classification.

Results

The foramen ovale was successfully punctured in all 11 patients and entered Meckel’s Cave, the balloon was then filled to create a “pear shape”. Immediate complete healing was achieved in 10 patients and delayed healing was achieved in one patient by the 5th postoperative day. No serious complications were identified that were related to surgery, and over a follow-up time of 1–12 months, there was no recurrence of pain, and a BNI numbness grade of 2–3 points. The appropriate ratio of the balloon inflated volume to the preoperative Meckel’s Cave volume was approximately 1.7.

Conclusion

Preliminary clinical application and short-term follow-up showed that robot-assisted PBC surgery is a safe and effective surgical method for elderly patients with trigeminal neuralgia.

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© 2023 Tan et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution - Non Commerical (unported, v3.0) License. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

Keywords:

• trigeminal neuralgia
• robotics
• percutaneous balloon compression
• stereotactic neurosurgery
• technique

Statement of Ethics

The studies involving human participants were reviewed and approved by Medical Ethics Committee of BeiJing ChaoYang Hospital, Capital Medical University. The patients provided their written informed consent prior to the procedure to participate in this surgery and to view their medical records. Data reported in the study have been completely anonymized. The confidentiality of patient data is in accordance with the Declaration of Helsinki.

Disclosure

The authors declare that this research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Additional information

Funding

This research was funded by the Innovation Technology Project, Beijing Chao-Yang Hospital, Capital Medical University (Reference: 22KCJJYB-4) in the preparation of data and the manuscript.