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Pain Rapid Fire Abstract

Pain

Efficacy and Safety of Microvascular Decompression with or without Partial Sensory Rhizotomy: A Comprehensive Meta-Analysis and Systematic Review in Treating Trigeminal Neuralgia

Saturday, May 4, 2024
4:40 PM – 4:42 PM CT
Location:  S405b
Disclosure(s):
MARCELO P. Porto Sousa: No financial relationships to disclose
Introduction: Classical trigeminal neuralgia (TN) caused by vascular compression of the nerve root, is a serious cause of pain with 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%. The objective of this review and meta-analysis is to ascertain the efficacy and safety profile of MVD + PSR when compared to standalone MVD.

Methods: Medline, Embase, and Web of Science were searched for English-language studies from January 2000 to October 2023, in accordance with PRISMA guidelines. A total of seven articles comparing MVD with MVD + PSR were selected for inclusion in this systematic review. The risk of bias was assessed through the ROBINS-I tool.

Results: After retrieving 1959 articles, 1338 total patients across seven studies were finally included. Assessed outcomes included: effectiveness and complete resolution of TN-associated pain, procedural complications - facial numbness, hearing loss, intracranial bleeding - and mortality were analyzed. Random-effects analysis of total pain resolution demonstrated a relative risk of 0.90 (95% CI: 0.85 - 0.96, I² = 0%), favoring MVD + PSR. General pain improvement also slightly favored MVD + PSR (RR: 0.95; 95% CI: 0.90 - 0.90, I² = 42%), although the procedure was linked to a significantly higher risk of post-procedural facial numbness (RR: 0.12; 95% CI: 0.04 - 0.37, I² = 62%). No statistically significant differences were observed in post-procedural hearing loss, intracranial bleeding, or mortality rates between each intervention.

Conclusion : MVD + PSR seems to offer superior efficacy in the treatment and resolution of trigeminal neuralgia. The benefit appears to be marginal, however, when compared to the increased rates of facial numbness following the procedure. Further studies could help in better understanding which patient profile would benefit most from this indication.