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

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

doi:10.3389/fsurg.2022.869223

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

Front Surg. 2022 Mar 18:9:869223. doi: 10.3389/fsurg.2022.869223. eCollection 2022.

Authors

Qiangqiang Liu^{1

2}, Junjie Wang², Changquan Wang², Wenze Chen², Wenzhen Chen^{1

2}, Xiaolai Ye^{1

2}, Ziyu Mao², Chencheng Zhang^{3

4}, Jiwen Xu^{1

2}

Affiliations

¹ Department of Neurosurgery, Clinical Neuroscience Center Comprehensive Epilepsy Unit, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² Clinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
³ Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁴ Shanghai Research Center for Brain Science and Brain-Inspired Technology, Shanghai, China.

Abstract

Objective: Percutaneous balloon compression (PBC) is a minimally invasive treatment for trigeminal neuralgia (TG) with a favorable cost-effectiveness ratio, but this technique has a steep learning curve. This study presents our initial clinical experience of robot-assisted PBC using a neurosurgical robot on six consecutive patients with TG.

Methods: We fixed the patient's head with a skull clamp and connected it with the linkage arms of a Sinovation^® neurosurgical robot, which was then registered using four bone fiducials by the robotic pointer. The puncture needle was positioned at the entry point on the skin using a robotic arm and advanced to the target point after the skin had been incised with a pointed surgical blade. This procedure was repeated for a second trajectory. A balloon was then advanced and inflated using 0.3 ml of a contrast agent. Upon injection of 0.6 ml contrast agent, the ganglion was kept compressed for 120 s. After removal of the balloon and puncture needle, compression of the face was performed to achieve hemostasis.

Results: All patients achieved immediate pain relief following PBC. No permanent or severe complications were registered, and there was no pain recurrence in any of the patients during the follow-up period.

Conclusions: Despite requiring a longer time for preoperative preparation, robot-assisted PBC provided a high degree of accuracy and safety, and it can also shorten the learning curve for surgeons unfamiliar with PBC. Robot-assisted surgical approaches should be further developed and adopted for PBC.

Keywords: percutaneous balloon compression; robotics; stereotactic neurosurgery; technique; trigeminal neuralgia.