Microvascular decompression in glossopharyngeal neuralgia: a systematic review and meta-analysis

Glossopharyngeal neuralgia (GPN) is a rare craniofacial pain disorder causing paroxysmal throat and ear pain. For medically refractory cases, microvascular decompression (MVD) targets the underlying neurovascular compression and offers a potentially curative treatment. This systematic review and meta-analysis aimed to evaluate the efficacy, safety, and durability of MVD for GPN and identify predictors of outcome.

A comprehensive search of PubMed, Embase, Scopus, and Web of Science was conducted up to August 24, 2025, following PRISMA guidelines. Eligible studies included patients with clinically or radiologically confirmed GPN treated with MVD. Pooled estimates were calculated using random- or fixed-effects models, and heterogeneity, publication bias, and meta-regression analyses were performed.

Twenty-five studies encompassing 1,009 patients were analyzed. The pooled rate of initial complete pain relief was 94.2% (95% CI: 90.2-97.3%), and long-term complete relief was 92.1% (95% CI: 86.9-96.2%). Pain recurrence occurred in 2.3% (95% CI: 0.5-4.8%), and permanent complications in 1.7% (95% CI: 0.2-4.2%). Meta-regression identified longer disease duration and prior MVD as negative predictors, while arterial compression and older age favored better outcomes.

MVD provides excellent and durable pain relief with minimal morbidity, confirming its role as the gold-standard treatment for classical GPN. Prospective, standardized studies are warranted to refine patient selection and optimize outcomes.