Kesumayadi Irfan, Hosoya Tomohiro, Yoshioka Hiroki, Amisaki Hidefumi, Uno Tetsuji, Kambe Atsushi, Sakamoto Makoto, Kurosaki Masamichi
Department of Brain and Neurosciences, Division of Neurosurgery, Faculty of Medicine, Tottori University, Tottori, Japan.
Neurosurg Rev. 2025 May 8;48(1):408. doi: 10.1007/s10143-025-03562-6.
Microvascular decompression (MVD) remains the most effective treatment for managing trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia. Despite variations in technique, the clinical outcomes of transposition and interposition for MVD have shown mixed results. Here, we use a meta-analysis approach to evaluate the clinical outcomes of transposition versus interposition techniques for trigeminal neuralgia and hemifacial spasm. We systematically retrieved articles published before August 31, 2024, from PubMed, the Cochrane Library Database, and Web of Science. Our analysis included 9 studies encompassing 1,392 patients. We found that transposition was performed more frequently (58.8%) than interposition (42.2%). Both techniques exhibited comparable clinical outcomes for early spasm resolution (92.81% vs. 86.64%; OR [odd ratio] = 1.09; 95% CI [confidence interval], 0.27-4.37; p = 0.907), recurrence rates (5.57% vs. 6.34%; OR = 0.71; 95% CI, 0.32-1.60; p = 0.410), and overall postoperative complications (12.24% vs. 12.93%; OR = 1.01; 95% CI, 0.67-1.54; p = 0.951). Transposition demonstrated superior postoperative total resolution compared to interposition (90.17% vs. 86.25%; OR = 2.14; 95% CI, 1.48-3.11; p < 0.001). A subgroup analysis demonstrated that this superior postoperative total resolution only found in hemifacial spasm (96.73% vs. 90.90%; OR = 3.54; 95% CI, 1.78-7.07; p < 0.001) but not in trigeminal neuralgia (83.38% vs. 77.42%; OR = 1.77; 95% CI, 0.72-4.37; p = 0.213). In conclusion, this meta-analysis demonstrates that both techniques show comparable clinical outcome in early spasm resolution, recurrence rate, and postoperative complications, but transposition achieves superior postoperative total resolution outcomes. These findings suggest that transposition is a preferable approach whenever possible, i.e., in patients with hemifacial spasm, while interposition remains a reliable alternative.
微血管减压术（MVD）仍然是治疗三叉神经痛、面肌痉挛和舌咽神经痛最有效的方法。尽管技术存在差异，但MVD中转位术和置入术的临床结果喜忧参半。在此，我们采用荟萃分析方法来评估三叉神经痛和面肌痉挛中转位术与置入术的临床结果。我们系统检索了截至2024年8月31日在PubMed、Cochrane图书馆数据库和科学网发表的文章。我们的分析纳入了9项研究，共1392例患者。我们发现转位术的实施频率（58.8%）高于置入术（42.2%）。两种技术在早期痉挛缓解（92.81%对86.64%；比值比[OR]=1.09；95%置信区间[CI]，0.27 - 4.37；p = 0.907）、复发率（5.57%对6.34%；OR = 0.71；95% CI，0.32 - 1.60；p = 0.410）和总体术后并发症（12.24%对12.93%；OR = 1.01；95% CI，0.67 - 1.54；p = 0.951）方面显示出相当的临床结果。与置入术相比，转位术在术后总缓解率方面表现更优（90.17%对86.25%；OR = 2.14；95% CI，1.48 - 3.11；p < 0.001）。亚组分析表明，这种术后总缓解率的优势仅在面肌痉挛中发现（96.73%对90.90%；OR = 3.54；95% CI，1.78 - 7.07；p < 0.001），而在三叉神经痛中未发现（83.38%对77.42%；OR = 1.77；95% CI，0.72 - 4.37；p = 0.213）。总之，这项荟萃分析表明，两种技术在早期痉挛缓解、复发率和术后并发症方面显示出相当的临床结果，但转位术在术后总缓解率方面更优。这些发现表明，只要有可能，转位术是更可取的方法，即对于面肌痉挛患者，而置入术仍然是一种可靠的替代方法。
