First treatment and retreatment of medically refractive trigeminal neuralgia by stereotactic radiosurgery versus microvascular decompression: a systematic review and Meta-analysis

<p><b>Purpose:</b> Procedures to treat medically refractory trigeminal neuralgia (MRTN) include stereotactic radiosurgery (SRS) and microvascular decompression (MVD). The aim of this study was to compare outcomes of SRS versus MVD in the treatment of MRTN, with a subgroup focus on those being treated for the first time.</p> <p><b>Methods:</b> Search strategy was performed using the PRISMA guidelines for article identification, screening, eligibility and inclusion. Relevant articles were identified from six electronic databases from their inception to June 2017. These articles were screened against established criteria for inclusion into this study. Meta-analysis was conducted by pooling results with odds ratios and subgroup analysis.</p> <p><b>Results:</b> From 13 relevant studies identified, 683 patients treated by SRS were compared with 670 patients treated by MVD for MRTN. Overall, the significant findings were that compared to MVD, SRS was associated with lower rates of short-term (OR = 0.16; 95%CI = 0.11–0.22; <i>p</i> < .001) and long-term pain freedom (OR = 0.31; 95%CI = 0.22-0.44; <i>p</i> < .001), fewer postoperative complications (OR = 0.06; 95%CI = 0.02–0.16; <i>p</i> < .001), more facial numbness and dysesthesia (OR = 1.64; 95%CI = 1.08–2.49; <i>p</i> = .02), and more pain recurrence (OR = 2.28; 95%CI = 1.32–3.93; <i>p</i> = .003). These trends were all reflected in MRTN patients being treated for the first time.</p> <p><b>Conclusion:</b> Both SRS and MVD alleviate pain in MRTN patients. MVD results in superior rates of short- and long-term pain relief, facial numbness and dysesthesia control, and less recurrence amongst those in whom pain freedom was achieved, at the cost of greater postoperative complications when compared to SRS. Although no significant difference was found in terms of the need for retreatment surgery, there was a trend towards less procedures favoring MVD. First treatment by either technique represents the overall trends reported.</p>