Microvascular decompression and radiofrequency for the treatment of trigeminal neuralgia: a meta-analysis
Received 30 January 2019
Accepted for publication 28 May 2019
Published 28 June 2019 Volume 2019:12 Pages 1937—1945
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr E Alfonso Romero-Sandoval
Yan Li,1–3 Liqiang Yang,1,2 Jiaxiang Ni,1,2 Zhi Dou1,2
1Department of Pain Management, Xuanwu Hospital, Capital Medical University, Beijing 100053, People’s Republic of China; 2National Center for Clinical Medicine of Geriatric Diseases, Beijing 100053, People’s Republic of China; 3Center for Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, People’s Republic of China
Purpose: Surgical treatments are used for trigeminal neuralgia (TN) when drug treatment fails. Surgical options can be divided into two categories: ablation (destructive) or non-ablation. Microvascular decompression (MVD) is primarily a non-ablation option, while radiofrequency thermocoagulation/rhizotomy (RF) is an ablation option. The aim of this study was to compare outcomes of MVD versus RF in the treatment of TN.
Materials and methods: This article evaluates the clinical results and economic effectiveness of trigeminal nerve RF and MVD for the treatment of TN. This review was conducted according to the methodological standards described in the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. The PubMed, Embase and Cochrane libraries were searched in January 2018. We have registered our review at the Review Registry.
Results: Nine studies were included in this review. The sample size was 2163 participants. The results showed that compared with RF, MVD had a lower risk of requiring a secondary procedure. The MVD group also had a lower risk of facial numbness. There was no significant difference in postoperative medication use between the two groups. Compared to RF, MVD was more likely to increase the risk of hypacusis and hypesthesia and to decrease the risk of facial pain and dysesthesia. The total cost of MVD, including the operation, hospital stay and additional procedures, was much higher than that of RF.
Conclusion: MVD had a lower risk of requiring a secondary procedure and facial numbness after surgery. RF could be considered in patients who are unfit for MVD or refused invasive treatment.
Keywords: meta-analysis, facial pain, surgical treatment
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