Centro universitário FMABC, Santo André, São Paulo, Brazil.
Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil.
J Clin Neurosci. 2023 Mar;109:11-20. doi: 10.1016/j.jocn.2023.01.002. Epub 2023 Jan 10.
Trigeminal neuralgia (TN) is a neuropathic pain that affects one or more branches of the trigeminal nerve. Surgical options after pharmacological failure are Microvascular Decompression (MVD) or percutaneous procedures, which include Balloon Compression (PBC). This study aims to describe pain outcomes and complications after PBC and MVD procedures for patients with trigeminal neuralgia.
We performed a systematic review and meta-analysis on PubMed, EMBASE, LILACS, and Web of Science databases up to April 2022, following PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and meta-Analysis). Articles that separately describe pain outcome for MVD and PBC were included. MINORS tool was used for bias assessment. Meta-analysis results are presented in forest plot and funnel plot.
853 studies were assessed for screening, and 11 studies met the inclusion criteria for this review. A total of 1046 patients underwent PBC and 1324 underwent MVD. The subgroup analysis for patients without multiple sclerosis shows that MVD was associated with lower number of patients with pain than PBC, with an OR value of 0.54 (95 % CI 0.34-0.84). All other analyses evidenced a tendency for better outcomes after the MVD procedure, but with no statistically significant difference.
Considering short and long pain relief, recurrence of pain and total complications for MVD and PBC, our study found that MVD is the best surgical option available for trigeminal neuralgia.
三叉神经痛（TN）是一种影响三叉神经的一个或多个分支的神经性疼痛。药物治疗失败后的手术选择是微血管减压术（MVD）或经皮手术，包括球囊压迫术（PBC）。本研究旨在描述三叉神经痛患者接受 PBC 和 MVD 手术后的疼痛结果和并发症。
我们按照 PRISMA 指南（系统评价和荟萃分析的首选报告项目），对 PubMed、EMBASE、LILACS 和 Web of Science 数据库进行了系统评价和荟萃分析，截至 2022 年 4 月。单独描述 MVD 和 PBC 疼痛结果的文章被纳入。MINORS 工具用于评估偏倚。荟萃分析结果以森林图和漏斗图呈现。
有 853 项研究进行了筛选，有 11 项研究符合本综述的纳入标准。共有 1046 例患者接受了 PBC 治疗，1324 例患者接受了 MVD 治疗。在没有多发性硬化症的患者亚组分析中，MVD 与 PBC 相比，疼痛患者的数量较少，比值比（OR）值为 0.54（95%可信区间 0.34-0.84）。所有其他分析都表明 MVD 手术后的结果更好，但没有统计学上的显著差异。
考虑到短期和长期的疼痛缓解、疼痛复发和 MVD 和 PBC 的总并发症，我们的研究发现 MVD 是治疗三叉神经痛的最佳手术选择。
