三叉神经经皮球囊压迫术麻醉方式的 研究进展

Research Progress on Anesthetic Modalities for Percutaneous Balloon Compression of the Trigeminal Ganglion

摘要: 经皮球囊压迫术(PBC)已成为三叉神经痛的一线微创治疗方案，但术中剧烈疼痛及三叉神经–心脏反射(TCR)仍是麻醉管理的核心难点。全身麻醉可提供完善的镇静镇痛与气道控制，但对高龄及合并症患者耐受性差，且TCR发生风险较高。局部麻醉血流动力学稳定、TCR发生率低，但镇痛不全、患者舒适度差及术中配合困难等问题突出，高度依赖术者经验。监护下麻醉(MAC)在局麻基础上辅助镇静镇痛，兼顾清醒配合与术中舒适，成为研究热点，但常用药物如舒芬太尼、咪达唑仑存在呼吸抑制或个体差异大等局限，右美托咪定虽呼吸影响小，但对TCR的影响尚存争议。CT导航技术为局麻与MAC的应用提供了有利条件。目前PBC麻醉方式尚无统一标准，本综述拟将目前三叉神经经皮球囊压迫术麻醉方式的选择及研究进展作一阐述。

Abstract: Percutaneous balloon compression (PBC) has become a first-line minimally invasive treatment for trigeminal neuralgia; however, severe intraoperative pain and the trigemino-cardiac reflex (TCR) remain central challenges in anesthesia management. General anesthesia provides adequate sedation, analgesia, and airway control, yet it is poorly tolerated in elderly patients with comorbidities and is associated with a high risk of TCR. Local anesthesia offers more stable hemodynamics and a lower incidence of TCR, but is limited by insufficient analgesia, poor patient comfort, and difficulty in intraoperative cooperation, and is highly dependent on operator experience. Monitored anesthesia care (MAC), which combines local anesthesia with adjuvant sedative-analgesic agents, preserves patient cooperation while improving comfort and has become a research focus. However, commonly used drugs such as sufentanil and midazolam are associated with respiratory depression or significant interindividual variability, and although dexmedetomidine has minimal respiratory effects, its impact on TCR remains controversial. The widespread use of CT-guided navigation has facilitated the application of local anesthesia and MAC. Currently, no unified anesthesia standard exists for PBC. This review aims to summarize the current anesthesia options and research progress in PBC.