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Microvascular Decompression: Salient Surgical Principles and Technical Nuances
Published on: July 5, 2011
Stereotactic radiosurgery for trigeminal neuralgia secondary to vertebrobasilar dolichoectasia: A systematic review
Bardia Hajikarimloo1, Salem M Tos1, Ibrahim Mohammadzadeh2
1Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA.
Background:
Trigeminal neuralgia (TN) secondary to vertebrobasilar dolichoectasia (VBD) is a rare and surgically challenging condition due to the complex anatomy and elevated risks of open craniotomies. Stereotactic radiosurgery (SRS) offers a minimally invasive alternative, but evidence has been limited to small case series with variable outcomes. To address this gap, we conducted the first meta-analysis to evaluate the efficacy and safety of SRS for VBD-related TN.
Methods:
Following PRISMA guidelines, PubMed, Embase, Scopus, and Web of Science were searched from inception to August 2025. Statistical analyses were performed in R. Sensitivity analyses, publication bias assessment, and meta-regression were conducted.
Results:
Five studies involving 90 patients were included. The pooled initial complete pain relief rate was 68% (95% confidence interval [CI]: 6%-100%), and initial adequate pain relief was 95% (95% CI: 77%-100%). At the final follow-up, complete pain relief was reported in 28% (95% CI: 0%-72%) of cases, and adequate relief was reported in 81% (95% CI: 43%-100%) of cases. Pain recurrence occurred in 44% (95% CI: 7%-85%), while 39% (95% CI: 0%-91%) required salvage interventions. Transient facial sensory disturbance was 19% (95% CI: 0%-97%), and permanent facial sensory disturbance was negligible at 0% (95% CI: 0%-4%). Meta-regression identified vascular anatomy, trigeminal division involvement, and sex distribution as significant predictors of outcome.
Conclusions:
SRS provides meaningful pain relief with minimal permanent toxicity in VBD-related TN. Nonetheless, recurrence and salvage needs remain substantial, underscoring the importance of prospective studies to refine patient selection and treatment strategies.
