(312) Microvascular Decompression Versus Less-Invasive Interventions for Primary Trigeminal Neuralgia

Introduction: The widely accepted treatment of primary trigeminal neuralgia (PTN) is microvascular decompression of the trigeminal nerve root, although other less-invasive interventions are available. We aim to comprehensively analyze the efficacy of MVD as well as the proportions of procedure failure, re-operation, and complications compared to less-invasive procedures.

Methods: A literature search was conducted from February to May 2023 in accordance with PRISMA recommendations using PubMed, Medline, and Scopus to identify studies comparing MVD to other interventions for PTN. Interventions included for meta-analysis were percutaneous balloon microcompression (PBC), radiofrequency rhizotomy (RFR), and stereotactic radiosurgery (SRS). All subjects were diagnosed with primary trigeminal neuralgia and were surgically naive. The Barrow Neurological Institute (BNI) Pain Intensity Score was used to determine procedure success or failure. Demographic information, reported complications, and re-operation were also recorded. Outcomes were reported as single means and proportions which were meta-analyzed and compared at a 95% confidence interval.

Results: Seventeen studies were included for analysis with a total of 2756 patients. Pain relief was greater in MVD (88.37%) compared to RFR (57.35%) and SRS (73.75%) (p-values < 0.0001) but not significantly different between MVD and PBC (p = 0.7533). The proportion of patients requiring re-operation was less in MVD (9.57%) compared to RFR (54.03%) and SRS (18.11%) (p < 0.0001 and p = 0.0005, respectively). The proportion of post-operative complications was greater following MVD (13.50%) compared to both RFR (8.39%) and SRS (2.34%) (p = 0.0288 and p < 0.0001, respectively).

Conclusions: The authors conclude that patients undergoing MVD were more likely to experience a successful outcome than patients undergoing RFR or SRS. This supports the literature proposing neurovascular compression as the etiology of primary trigeminal neuralgia. However, the invasiveness of MVD leads to a higher proportion of patients experiencing post-operative complications.