Purely Endoscopic Microvascular Decompression for Trigeminal Neuralgia: Systematic Review and Single Arm Meta-Analysis

Introduction: Microscopic microvascular decompression(M-MVD) is considered the gold standard treatment for primary trigeminal neuralgia with excellent long-term pain control rates. Despite the effectiveness of M-MVD, the use of endoscopy in these procedures has proven to be a promising approach, with increasingly robust results. In this study, we evaluate the safety and efficacy of purely endoscopic microvascular decompression pE-MVD.

Methods: A systematic review of the literature was performed using the PubMed, Scopus, Embase, and Cochrane databases. The primary outcome was satisfactory pain relief. Secondary outcomes included postoperative complications, the rate of intraoperative identification of the offending vessel(s), mortality, length of stay and operative time. Statistical analysis was performed using RStudio 2024.04.1+748. Heterogeneity was assessed using I² statistics.

Results: Thirteen articles met the inclusion criteria, comprising a total of 1336 patients. Patients submitted to pE-MVD had mean satisfactory pain relief rates of 92.93% (95% CI: 89.52-96.34% I2 = 86%), 88.54% (95% CI: 83.73-93.54% I2 = 87%) and 83.38% (95% CI: 76.58-90.17% I2 = 83%) in the short-term, mid-term and long-term follow-ups, respectively. Furthermore, the incidence of postoperative complications was low, including CSF leak (1.29% (95 % CI: 0.32-2.26% I2 = 20%)), and facial numbness (3.84%(95 % CI: 1.95-6.20% I2 = 54%)). There was no mortality related to the procedure and the offending vessels were identified in 99.57% of the cases (95 % CI: 98.17-100.00% I2 = 67%)).

Conclusion : Our meta-analysis revealed that pE-MVD is a safe and effective procedure for the treatment of primary trigeminal neuralgia and should be considered as an alternative to M-MVD.