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Efficacy and safety of microvascular decompression with or without partial sensory rhizotomy: a comprehensive meta-analysis and systematic review in treating trigeminal neuralgia

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Abstract

Classical trigeminal neuralgia (TN), caused by vascular compression of the nerve root, is a severe cause of pain with a considerable impact on a patient’s quality of life. While microvascular decompression (MVD) has lower recurrence rates when compared with partial sensory rhizotomy (PSR) alone, refractoriness can still be as high as 47%. We aimed to assess the efficacy and safety profile of MVD + PSR when compared to standalone MVD for TN. We searched Medline, Embase, and Web of Science following PRISMA guidelines. Eligible studies included those with ≥ 4 patients, in English, published between January 1980 and December 2023, comparing MVD vs. MVD + PSR for TN. Endpoints were pain cure, immediate post-operative pain improvement, long-term effectiveness, long-term recurrence, and complications (facial numbness, hearing loss, and intracranial bleeding). We pooled odds ratios (OR) with 95% confidence intervals with a random-effects model. I2 was used to assess heterogeneity, and sensitivity and Baujat analysis were conducted to address high heterogeneity. Eight studies were included, comprising a total of 1,338 patients, of whom 1,011 were treated with MVD and 327 with MVD + PSR. Pain cure analysis revealed a lower likelihood of pain cure in patients treated with MVD when compared to patients treated with MVD + PSR (OR = 0.30, 95% CI: 0.13 to 0.72). Immediate postoperative pain improvement assessment revealed a lower likelihood of improvement in the MVD group when compared with the MVD + PSR group (OR = 0.31, 95% CI: 0.10 to 0.95). Facial numbness assessment revealed a lower likelihood of occurrence in MVD alone when compared to MVD + PSR (OR = 0.08, 95% CI: 0.04 to 0.15). Long-term effectiveness, long-term recurrence, hearing loss, and intracranial bleeding analyses revealed no difference between both approaches. Our meta-analysis identified that MVD + PSR was superior to MVD for pain cure and immediate postoperative pain improvement for treating TN. However, MVD + PSR demonstrated a higher likelihood of facial numbness complications. Furthermore, identified that hearing loss and intracranial bleeding complications appear comparable between the two treatments, and no difference between long-term effectiveness and recurrence.

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Funding

This article was created without the utilization of any funding. All content and research presented do not involve any financial support or sponsorship from external sources.Disclosures: The authors have no personal, financial, or institutional interest in any of the materials described in this article.

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Authors and Affiliations

  1. Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

    Marcelo Porto Sousa, Guilherme Melo Silva, Gabriel Verly, Sávio Batista & Filipi Fim Andreão

  2. Faculty of Medicine, FMABC University Center, São Paulo, Brazil

    Christian Ken Fukunaga

  3. University of West of Santa Catarina, Santa Catarina, Brazil

    Gabriel da Silva Semione

  4. Technical-Educational Foundation Souza Marques, Rio de Janeiro, Brazil

    Pedro G L B Borges

  5. Department of Neurosurgery, State University of Ponta Grossa, Paraná, Brazil

    Leonardo B. Oliveira

  6. Faculty of Medicine, Ninth July University, São Paulo, SP, Brazil

    Márcio Yuri Ferreira

  7. Department of Neurosurgery, Mayo Clinic, Arizona, USA

    Herika Negri Brito

  8. Department Neurosurgery, University of São Paulo, São Paulo, Brazil

    Raphael Bertani

  9. Department of Neurology, University of São Paulo, São Paulo, Brazil

    Pedro Henrique Martins da Cunha

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  1. Marcelo Porto Sousa
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Contributions

F.F.A. helped the introduction, abstract and data analysis section of the article. M.P.S. and G.M.S. made the abstract, methodology section and discussion of the paper. C.K.F. and L.B.O. conducted the data extraction. G.S.S., P.B. and G.V. designed the meta-analysis results part. S.B. and M.Y.F. wrote the discussion and conclusion section. H.K.N.B., R.B. and P.H.M.C. assembled as senior authors and reviewed the manuscript.

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Correspondence to Christian Ken Fukunaga.

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Sousa, M.P., Fukunaga, C.K., Ferreira, M.Y. et al. Efficacy and safety of microvascular decompression with or without partial sensory rhizotomy: a comprehensive meta-analysis and systematic review in treating trigeminal neuralgia. Neurosurg Rev 47, 229 (2024). https://doi.org/10.1007/s10143-024-02463-4

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