• Arthur Gubian and Steffen K Rosahl.
• Department of Neurosurgery, HELIOS Klinikum Erfurt, Erfurt, Germany. Electronic address: arthur.gubian@yahoo.com.
• World Neurosurg. 2017 Jul 1; 103: 757-767.

BackgroundClassic trigeminal neuralgia is often treated pharmacologically first. However, microvascular decompression (MVD) or radiosurgical treatment (RS) can render medication unnecessary. Objective appraisals of the 2 treatment modalities are scarce.ObjectiveTo compare the evidence regarding safety and efficiency of MVD and RS.MethodsWe searched PubMed for studies describing pain control, complications, and recurrences after MVD or RS between 2005 and 2015. Because randomized studies are lacking, we focused the statistical analysis on cohort clinical trials. Differences in outcome after treatment with either MVD or RS were analyzed using t tests and weighted averages. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed.ResultsFifty-three studies (13,805 patients, in 11 prospective and 42 retrospective studies) were analyzed. Initial success rates were 71.1% for RS and 86.9% for MVD (P < 0.0001). At last follow-up (>5 years after intervention), success rates decreased to 63.8% for RS versus 84% for MVD (P = 0.036). Thirty-six months after the intervention, median percentage of recurrence was 11% for MVD and 25% for RS (P = 0.0015). The length of recurrence-free intervals was similar for MVD and RS (30.45 vs. 30.55 months; P = 0.987). There was no significant difference between the incidence of hearing loss after MVD and RS (1.51% vs. 0.74%; P = 0.21). Facial dysesthesia was reported more frequently after radiosurgery (2.3% vs. 28.8%; P = 0.02).ConclusionsMVD is a valid first-line treatment option for young patients free of comorbidities. First-line RS can be advised in patients with a higher surgical risk.Copyright © 2017 Elsevier Inc. All rights reserved.

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