Endoscopic vs microscopic microvascular decompression for trigeminal neuralgia: a systematic review and meta-analysis

Area of Science:

• Neurosurgery
• Surgical Technology
• Pain Management

Background:

• Trigeminal neuralgia (TN) causes severe facial pain, often treated with microvascular decompression (MVD).
• Traditional microscopic MVD (M-MVD) has limitations, including a restricted surgical view.
• Endoscopic MVD (E-MVD) provides enhanced visualization, potentially improving surgical outcomes.

Purpose of the Study:

• To systematically compare the safety and efficacy of endoscopic MVD (E-MVD) versus microscopic MVD (M-MVD) for trigeminal neuralgia.
• To evaluate outcomes such as pain relief, recurrence rates, operative time, hospital stay, and adverse events.

Main Methods:

• A systematic review and meta-analysis adhering to PRISMA 2020 guidelines.
• Searched databases: PubMed, Embase, and Scopus.
• Included 9 studies with 1,205 patients (556 E-MVD, 649 M-MVD); assessed risk of bias using the Newcastle-Ottawa Scale.

Main Results:

• No significant difference in immediate postoperative pain relief between E-MVD and M-MVD.
• E-MVD demonstrated significantly lower recurrence rates and reduced hospital stays.
• E-MVD was associated with significantly reduced facial numbness and overall complications, with no difference in facial paralysis or hearing loss.

Conclusions:

• E-MVD offers comparable initial pain relief to M-MVD but potentially superior long-term durability and a better safety profile.
• Further randomized trials are needed to confirm if E-MVD should become the new surgical standard for trigeminal neuralgia.
• Endoscope-assisted MVD may represent an optimal technique, warranting further investigation.