Shanghai Fourth Hospital relieves patients of "trigeminal neuralgia" with robot + small balloon
Recently, the Department of Neurosurgery of Shanghai Fourth People's Hospital affiliated to Tongji University successfully implemented the "robot-assisted percutaneous transluminal trigeminal ganglion balloon compression surgery", allowing Mr. Wang, who had been suffering from trigeminal neuralgia for 4 years, to recover as normal and be discharged from the hospital smoothly.
It is understood that in late June, Mr. Wang from Taizhou, Zhejiang, had suffered from severe paroxysmal pain in the upper and lower right tooth roots, lower lip and cheek for more than four years. He was admitted to the Neurosurgery Department of Shanghai Fourth Hospital for treatment due to "right primary trigeminal neuralgia."
For more than 4 years, Mr. Wang has been taking "carbamazepine" intermittently, and the dosage is relatively large, but the effect is not good. Later, he received local radiofrequency thermocoagulation treatment at a local hospital, and the pain improved, but after one year of treatment, it recurred again.
In May this year, Mr. Wang's symptoms were significantly aggravated and the pain attacks were frequent. After asking around, he came to Shanghai Fourth Hospital's neurosurgery deputy chief physician Zhang Haitao for treatment. After admission, a complete trigeminal nerve MRI scan showed that the right trigeminal nerve root of Mr. Wang was closely related to a small artery, and microvascular decompression surgery was prepared for radical treatment. After a comprehensive examination and evaluation by the hospital, it was found that Mr. Wang had many underlying diseases: he had a history of hypertension for many years, had undergone coronary stent implantation for coronary heart disease 5 years ago, had decreased left ventricular systolic function, and was recently diagnosed with chronic renal failure.
After a multidisciplinary consultation, it was considered that the risk of anesthesia and postoperative bleeding in microvascular decompression surgery was high, and there was a high possibility of perioperative renal failure. After discussion, it was decided to use robot-assisted percutaneous trigeminal ganglion balloon compression surgery to relieve Mr. Wang's pain symptoms to the greatest extent and minimize the risk of surgery.
In late June, under the guidance of Zhang Zhiwen, director of the Department of Neurosurgery, Zhang Haitao performed the "robot-assisted percutaneous puncture of the trigeminal ganglion balloon compression" successfully. During the operation, the robot assisted in the puncture to the predetermined target of the foramen ovale near the right corner of the mouth under the precise positioning of the robot. After confirming the accuracy of the puncture position under the C-arm X-ray, the contrast agent was slowly injected and the balloon filling shape was observed to be "pear-shaped". After maintaining the compression for 2 minutes, the compression balloon was withdrawn and the operation was ended. The whole operation took about 30 minutes. After waking up from anesthesia, Mr. Wang's pain symptoms disappeared immediately. On the day after the operation, he resumed normal eating, was in good spirits, and returned to normal life.
Zhang Haitao introduced that trigeminal neuralgia is the most common cranial nerve disease. The pathogenesis of primary trigeminal neuralgia is still unclear. However, a large number of studies at home and abroad believe that demyelinating lesions in the area where the trigeminal nerve enters and exits the brainstem are the main cause of the disease, and compression of small blood vessels in this area is an important factor leading to demyelinating lesions, among which the superior cerebellar artery, the anterior inferior cerebellar artery and the petrosal vein branches are the most common. "Microvascular decompression is to find the blood vessels that compress the trigeminal nerve, then push the responsible blood vessels away and use insulating materials to pad between the blood vessels and the nerves, thereby relieving the compression on the nerve." Zhang Haitao explained, "Therefore, microvascular decompression is the most radical, long-term and preferred treatment for primary trigeminal neuralgia, but it is not suitable for patients with poor general condition, advanced age, comorbidities with other major underlying diseases, and those who refuse craniotomy."
Zhang Haitao said that in recent years, the application of neuronavigation robots in percutaneous trigeminal ganglion balloon compression has been widely recognized. It has the unique advantages of short operation time, safety, effectiveness and low cost, which complements the advantages of microvascular decompression. At the same time, compared with radiofrequency thermocoagulation, patients do not need to endure severe pain during the operation, have less mental stress, and have mild facial numbness symptoms after surgery, and sensory recovery is reversible, which is very suitable for patients who cannot tolerate or are unwilling to undergo surgery.
