Robot-Assisted Percutaneous Balloon Compression for Trigeminal Neuralgia: Technique Description and Short-Term Clinical Results

Liu, Qiangqiang; Wang, Junjie; Wang, Changquan; Chen, Wenze; Chen, Wenzhen; Ye, Xiaolai; Mao, Ziyu; Zhang, Chencheng; Xu, Junjie

doi:10.3389/fsurg.2022.869223

Cited by 4 publications

(6 citation statements)

References 26 publications

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“…Structured light registration markers, such as inner canthus, lateral canthus and nasal tip, are fixed in positions. Although the error of structured light is a little big, [ 14 ] we know the error though verifications and make adjustments accordingly. In our study, structured light registration was used and the mean registration error was just 0.68 mm, and all cases were punctured into the foramen ovale one time.…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted percutaneous balloon compression for trigeminal neuralgia- preliminary experiences

Sun

et al. 2023

BMC Neurol

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Objectives This study aims to discuss the availability of robot-assisted percutaneous balloon compression (PBC) for trigeminal neuralgia (TN) and share our preliminary experiences. Methods Patients with TN who underwent robot-assisted PBC from June to September 2022 were enrolled. We designed a fixing plug for robot-assisted PBC, three-dimensional structured light registration was used, puncture trajectory was the line connects the medial third of inner and outer aperture of foramen ovale. Numerical Rating Scale (NRS), Barrow Neurological Institute (BNI) pain and numbness intensity score were used to evaluate the facial pain and numbness. Results Eventually, nine patients were enrolled, the structured light registrations were successfully finished in all patients with a mean registration error of 0.68 mm. All the punctures of foramen ovales were successfully done one-time. Of note, the balloons were all got pear-shaped followed by 150 to 180 s compression. Though, postoperatively, all the patients complained of facial numbness and four patients suffered from transient masseter weakness, all patients got fully or mostly pain relief. It should be noted that is the numbness and weakness gradually relieved during follow-up. Conclusion Three-dimensional structured light registration and robot assisted PBC is an effective choice for patients with TN. Extension line between the medial third of the inner and outer aperture of foramen ovale might be a safe and effective puncture trajectory to this procedure.

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Section: Discussionmentioning

confidence: 99%

Robot-assisted percutaneous balloon compression for trigeminal neuralgia- preliminary experiences

Sun

et al. 2023

BMC Neurol

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“…The first cases of robotic-guided procedures for PBC were reported in August 2022, compared to other neuronavigational methods, robotics offers distinct advantages including increased precision, dexterity, durability, and resilience to fatigue that ultimately may result in improved safety and accuracy. 5 , 6 Consequently, this procedure has a certain learning curve and that is more dependent on the experience of the surgeon, especially when there are anatomical variations in a patient, this may lead to uncontrollable surgical risks.…”

Section: Discussionmentioning

confidence: 99%

“…The success rate with regards to forming a “pear” is high, and the surgical effect is significantly improved; with this respect, our results are consistent with those published previously. 6 With the inherent anatomical position and direction of the foramen ovale, the puncture direction from the foramen ovale into Meckel’s Cave and the direction of the puncture path from the outer skin of the corner of the mouth to the foramen ovale has a certain downwards and outwards angle. If the plan is to puncture from the outer corner of the mouth to Meckel’s Cave, the skin puncture point will be too low.…”

Section: Discussionmentioning

confidence: 99%

“… 4 New neuronavigational methods including robot-assisted techniques have been reported for PBC surgery. 5 , 6 Beijing Chaoyang Hospital Affiliated to Capital Medical University completed 11 cases of PBC surgery in elderly patients with TN (≥65 years-of-age) between August 2021 and August 2022, by deploying neurosurgery navigation and positioning planning system (referred to hereafter as the robot). During these surgeries, we achieved clinical results with good curative effects.…”

Section: Introductionmentioning

confidence: 99%

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

Tan¹,

Li²,

Peng³

et al. 2023

JPR

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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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“…Moreover, the neuronavigation technique may be an alternative for specific patients with significant anatomical variants that cause unsuccessful foramen ovale puncture. [34][35][36][37][38] Previously, clinicians emphasized the importance of the foramen ovale puncture. If the imaging technology is in its infancy and the operator is not skilled, the time taken to find the foramen ovale is often long.…”

mentioning

confidence: 99%

The Focus and New Progress of Percutaneous Balloon Compression for the Treatment of Trigeminal Neuralgia

Xia¹,

Yu²,

Min³

et al. 2022

JPR

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Trigeminal neuralgia is a condition confined to the trigeminal nerve, causing one or more branches of facial nerve pain. Surgical treatment options for trigeminal neuralgia include microvascular decompression(MVD), percutaneous balloon compression (PBC), radiofrequency thermocoagulation(RF), percutaneous retrogasserian glycerol rhizotomy(PRGR), gamma knife, etc. Of these treatments, PBC is increasingly being used by clinicians for trigeminal neuralgia. PBC is a simple surgical operation performed to treat trigeminal neuralgia. Owing to its advantages, PBC is favored by many clinicians. In this study, we aimed to emphasize the need to analyze the shape of the balloon, position, compression time, and pressure, as these factors can affect the efficacy of PBC. The relief of pain by balloon compression is related to the shape of the balloon on X-ray, which is the key to the operation. Owing to continued progress and advances in current imaging technologies, clinicians revealed that the precise positioning of the foramen ovale is no longer an intraoperative problem. Instead, the anatomy of Meckel's cave and the shape of the balloon must be the focus to achieve the best treatment effect. For clinicians, PBC is simple and is associated with a short operation time. PBC also has other advantages, such as low cost and immediate postoperative pain relief. The recurrence rate of pain post-PBC is low, despite the occurrence of facial numbness post-op. However, this side effect is reversible and does not affect daily life of the patient. In fact, the patient can be discharged 1-2 days after surgery. Overall, PBC can be considered as one of the preferred surgical methods for the treatment of primary trigeminal neuralgia. In this paper, we explain the main points of PBC operation in detail in terms of Meckel's cave, surgical procedure, complications, discussion of the focus and new progress, etc.

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Robot-Assisted Percutaneous Balloon Compression for Trigeminal Neuralgia: Technique Description and Short-Term Clinical Results

Cited by 4 publications

References 26 publications

Robot-assisted percutaneous balloon compression for trigeminal neuralgia- preliminary experiences

Robot-assisted percutaneous balloon compression for trigeminal neuralgia- preliminary experiences

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

The Focus and New Progress of Percutaneous Balloon Compression for the Treatment of Trigeminal Neuralgia

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