• Jayant Velagala, Zachary Scott Mendelson, and James K Liu.
• Neurosurgery. 2015 Aug 1;62 Suppl 1:228.

IntroductionThe most common surgical options for trigeminal neuralgia (TN) are microvascular decompression (MVD) and gamma knife surgery (GKS). Currently, there is no definitive consensus as to which of the 2 options is more effective at providing immediate and long-lasting pain relief. This study seeks to better evaluate the differences between these 2 options in terms of rates of complete pain relief and pain-free recurrence.MethodsA systematic review and meta-analysis was conducted on published studies of MVD and GKS for treatment of TN from 2004 to 2014. Cases were selected using a MEDLINE/PubMED search, as well as from subsequent inspection of the references from articles found in the initial search. Data were extracted regarding the rates of complete pain relief and pain-free recurrence. Complete pain relief was defined as being pain free without the use of medication (BNI grade I). Pain-free recurrence was defined as initially experiencing complete pain relief with a subsequent recurrence of pain.ResultsEighteen articles with a total of 2650 patients were included in the MVD group, while 25 articles with a total of 2846 patients were included in the GKS group. MVD was found to have a significantly higher rate of initial pain-free outcomes (BNI grade I) compared with GKS (92.22% vs 61.46%, P < .0001). MVD was also found to have a significantly lower pain-free recurrence rate compared with GKS (14.93% vs 19.38%, P < .0001). Additionally, MVD was also found to have a significantly higher rate of long-term pain-free outcomes at last follow-up compared with GKS (79.37% vs 41.62%, P < .0001).ConclusionMVD may be a more effective intervention than GKS because of the higher rates of initial pain-free outcomes and long-term pain-free outcomes, and lower rates pain-free recurrences.

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