Endoscopic Microvascular Decompression versus Microscopic Microvascular Decompression for Trigeminal Neuralgia: A Meta-Analysis of 581 Patients

Introduction: Trigeminal neuralgia (TN) is a chronic pain condition most commonly associated with compression of the trigeminal nerve. Microvascular decompression (MVD) is the standard of care for drug-resistant TN, performed using either microscopic (M-MVD) or endoscopic (E-MVD) approaches. The relative effectiveness and safety of both surgical modalities remain controversial. This meta-analysis aims to compare E-MVD and M-MVD in terms of efficacy, safety, and postoperative complications.

Methods: We conducted a comprehensive database search up to September 15th, 2024, and identified observational studies comparing E-MVD and M-MVD. The primary outcome was pain relief (measured by the Barrow Neurological Institute score 1-2). Secondary outcomes included operation time and postoperative complications. Pooled risk ratios (RR) and standardized mean differences (SMD) were calculated using a random-effects model.

Results: Six cohort studies involving 581 patients met the inclusion criteria. There was no difference in rates of Pain relief at 2 weeks postoperatively (RR=1.03, 95%CI=0.97, 1.09, p=0.4) or at 12 months of follow-up (RR=1.02, 95%CI= 0.94, 1.11, p=0.60). There was no significant difference in operative time (SMD=0.23, 95%CI=-0.04, 0.49, p=0.09). Additionally, there was no difference in rates of postoperative hearing loss (RR=0.91, 95%CI= 0.35, 2.33, p=0.84), facial numbness (RR= 0.86, 95%CI= 0.51, 1.46, p= 0.57), and CSF leaks (RR= 0.87, 95%CI= 0.15, 4.92, p= 0.87). However, E-MVD showed a higher incidence of postoperative headaches (RR= 0.45, 95%CI= 0.21, 0.96, p= 0.04).

Conclusion : Both E-MVD and M-MVD provide effective pain relief for TN, with similar operative times and rates of pain relief. However, E-MVD was linked to a higher rate of postoperative headaches. Our findings indicate that both surgical modalities offer similar efficacy and safety. Larger multicenter studies are needed to better understand the benefits of each technique and to guide personalized surgical decision-making for TN treatment.