Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Faculty of Medicine, FMABC University Center, São Paulo, Brazil.
Neurosurg Rev. 2024 May 24;47(1):229. doi: 10.1007/s10143-024-02463-4.
Classical trigeminal neuralgia (TN), caused by vascular compression of the nerve root, is a severe cause of pain with a considerable impact on a patient's quality of life. While microvascular decompression (MVD) has lower recurrence rates when compared with partial sensory rhizotomy (PSR) alone, refractoriness can still be as high as 47%. We aimed to assess the efficacy and safety profile of MVD + PSR when compared to standalone MVD for TN. We searched Medline, Embase, and Web of Science following PRISMA guidelines. Eligible studies included those with ≥ 4 patients, in English, published between January 1980 and December 2023, comparing MVD vs. MVD + PSR for TN. Endpoints were pain cure, immediate post-operative pain improvement, long-term effectiveness, long-term recurrence, and complications (facial numbness, hearing loss, and intracranial bleeding). We pooled odds ratios (OR) with 95% confidence intervals with a random-effects model. I was used to assess heterogeneity, and sensitivity and Baujat analysis were conducted to address high heterogeneity. Eight studies were included, comprising a total of 1,338 patients, of whom 1,011 were treated with MVD and 327 with MVD + PSR. Pain cure analysis revealed a lower likelihood of pain cure in patients treated with MVD when compared to patients treated with MVD + PSR (OR = 0.30, 95% CI: 0.13 to 0.72). Immediate postoperative pain improvement assessment revealed a lower likelihood of improvement in the MVD group when compared with the MVD + PSR group (OR = 0.31, 95% CI: 0.10 to 0.95). Facial numbness assessment revealed a lower likelihood of occurrence in MVD alone when compared to MVD + PSR (OR = 0.08, 95% CI: 0.04 to 0.15). Long-term effectiveness, long-term recurrence, hearing loss, and intracranial bleeding analyses revealed no difference between both approaches. Our meta-analysis identified that MVD + PSR was superior to MVD for pain cure and immediate postoperative pain improvement for treating TN. However, MVD + PSR demonstrated a higher likelihood of facial numbness complications. Furthermore, identified that hearing loss and intracranial bleeding complications appear comparable between the two treatments, and no difference between long-term effectiveness and recurrence.
经典三叉神经痛（TN）是由神经根血管压迫引起的，是一种严重的疼痛原因，对患者的生活质量有相当大的影响。微血管减压术（MVD）与单纯部分感觉根切断术（PSR）相比，复发率较低，但仍有 47%的患者可能出现难治性。我们旨在评估 MVD+PSR 与单独 MVD 治疗 TN 的疗效和安全性。我们按照 PRISMA 指南搜索了 Medline、Embase 和 Web of Science。纳入的研究包括≥4 例患者、英文发表、1980 年 1 月至 2023 年 12 月之间、比较 MVD 与 MVD+PSR 治疗 TN 的研究。终点为疼痛缓解、术后即刻疼痛改善、长期疗效、长期复发和并发症（面部麻木、听力损失和颅内出血）。我们采用随机效应模型汇总优势比（OR）及其 95%置信区间。I ² 用于评估异质性，进行敏感性和 Baujat 分析以解决高异质性问题。纳入了 8 项研究，共包括 1338 例患者，其中 1011 例接受 MVD 治疗，327 例接受 MVD+PSR 治疗。疼痛缓解分析显示，与 MVD+PSR 治疗组相比，MVD 治疗组的疼痛缓解可能性较低（OR=0.30，95%CI：0.13 至 0.72）。术后即刻疼痛改善评估显示，与 MVD+PSR 组相比，MVD 组的改善可能性较低（OR=0.31，95%CI：0.10 至 0.95）。面部麻木评估显示，与 MVD+PSR 组相比，MVD 组的发生率较低（OR=0.08，95%CI：0.04 至 0.15）。长期疗效、长期复发、听力损失和颅内出血分析显示两种方法之间无差异。我们的荟萃分析表明，MVD+PSR 优于 MVD，可提高 TN 的疼痛缓解和术后即刻疼痛改善。然而，MVD+PSR 更有可能导致面部麻木并发症。此外，发现两种治疗方法的听力损失和颅内出血并发症似乎相当，长期疗效和复发无差异。
