Pain outcomes and safety in trigeminal neuralgia: a systematic review and meta-analysis comparing percutaneous...

This study is a systematic review and meta-analysis comparing the efficacy and safety of percutaneous balloon compression (PBC) and microvascular decompression (MVD) for trigeminal neuralgia (TN), which was reported (PROSPERO ID CRD420251117307). PubMed, Embase, Scopus, and Web of Science were systematically searched for studies covering each database's inception to January 2026. Eligible studies were comparative clinical studies reporting key outcomes of MVD or PBC in patients with TN. Reviews, non-clinical studies, and studies with insufficient data were excluded. Risk of bias was assessed employing the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool. ROBINS-I evaluation showed high confounding risk: 1 study moderate, 10 serious, mostly due to unadjusted baseline differences. Subgroup analysis based on follow-up duration was performed, and GRADE was applied to assess evidence certainty. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for possible predictors. During the study screening process, 616 studies were evaluated for inclusion eligibility, and 11 studies were included in this review (with a total of 1284 patients). Among these patients, 600 underwent PBC, while 684 were treated with MVD. For TN treatment, the overall effective rates of MVD and PBC were similar in the short term [OR = 0.98, 95% CI = 0.63-1.54] and long term [OR = 0.79, 95% CI = 0.56-1.10]. Pain recurrence was also comparable between MVD and PBC [OR = 1.35, 95% CI = 0.88-2.08]. In contrast, PBC was associated with a higher frequency of adverse reactions than MVD, with statistically significant differences observed in facial numbness, herpes, and masticatory muscle weakness. In the treatment of TN, PBC and MVD show no significant differences in pain outcomes and TN recurrence rates. However, the incidence of adverse reactions associated with PBC is notably higher than that with MVD.