球囊压迫术治疗三叉神经痛的技术优化进展

Advances in the Technical Optimization of Balloon Compression for Trigeminal Neuralgia

摘要: 三叉神经痛是一种以患者面部阵发性过电样疼痛为核心特征的颅神经痛，严重影响患者的日常生活。经皮穿刺球囊压迫术(PBC)凭借其损伤小、手术难度低、治疗费用少、适用范围广等优势，逐渐成为药物治疗无效、高龄不能耐受开颅手术患者的一线微创治疗方法之一。以往临床医师进行PBC手术操作时主要依赖于术中球囊的“梨形”形态作为衡量手术有效的标准，但是以梨形作为衡量手术疗效的标准主观性较强且不同患者的麦氏囊解剖形态差异较大，可能会使部分患者三叉神经半月结压迫不充分导致术后疗效较差或压迫过度使患者术后麻木、咀嚼肌无力等并发症发生率升高。近些年随着术中球囊压力计的引入，使操作者可以直观量化球囊对三叉神经节的压迫强度，也标志着PBC从既往经验性操作转向精准治疗。近几年相关研究表明，术中球囊压力强度与手术疗效和术后面部麻木程度显著相关，如果能将术中球囊压力维持在合适的范围，则能同时兼顾治疗效果和安全性。因此术中监测球囊压力有望成为优化PBC临床疗效的新标准。

Abstract: Trigeminal neuralgia is a type of cranial nerve pain characterized by paroxysmal electric shock-like sensations in the facial area, which severely impacts patients’ daily lives. Percutaneous balloon compression (PBC), with its advantages of minimal trauma, low surgical difficulty, reduced treatment costs, and wide applicability, has gradually become one of the first-line minimally invasive treatment options for patients who are unresponsive to medication or are elderly and unable to tolerate craniotomy. In the past, clinicians primarily relied on the “pear-shaped” morphology of the intraoperative balloon as the standard for measuring surgical efficacy during PBC procedures. However, using the pear shape as a criterion is highly subjective, and the anatomical morphology of Meckel’s cave varies greatly among patients. This may lead to insufficient compression of the trigeminal ganglion in some patients, resulting in poor postoperative outcomes, or excessive compression, increasing the incidence of complications such as postoperative numbness and masticatory muscle weakness. In recent years, the introduction of intraoperative balloon pressure monitors has allowed operators to visually quantify the compression intensity on the trigeminal ganglion, marking the transition of PBC from empirical operation to precision treatment. Relevant studies in recent years have indicated that intraoperative balloon pressure is significantly correlated with surgical efficacy and the degree of postoperative facial numbness. If the intraoperative balloon pressure can be maintained within an appropriate range, both therapeutic efficacy and safety can be achieved. Therefore, intraoperative monitoring of balloon pressure is expected to become a new standard for optimizing the clinical outcomes of PBC.