Efficacy of microvascular decompression versus percutaneous balloon compression in trigeminal neuralgia: a propensity-matched retrospective analysis.

To compare the efficacy and safety of microvascular decompression (MVD) and percutaneous balloon compression (PBC) in trigeminal neuralgia (TN) management, focusing on pain relief, recurrence, complications, and patient satisfaction.A retrospective cohort of 226 MVD and 127 PBC patients was analyzed after propensity score matching (PSM). Clinical baseline characteristics, surgical details, and postoperative follow-up information were collected. The primary outcome of this study was recurrent pain of TN, and the secondary outcome was facial numbness dissatisfaction. Univariate and multivariate Cox proportional hazards regression models were employed to assess potential predictors associated with pain recurrence.From May 2019 to May 2023, this study retrospectively collected 405 patients with TN: 265 underwent MVD and 140 received PBC. The overall cohort included 234 females (57.8%) with a median age of 68.0 years (range: 29.0-85.0 years), and baseline demographics, including symptom Duration, involved nerve branches, and comorbidities, showed no significant differences between groups. After a median follow-up of 34.0 months, pain recurrence occurred in 7.5% of the MVD group and 9.4% of the PBC group. Univariate Cox regression analysis revealed no significant difference in recurrence risk between PBC and MVD (Hazard Ratio [HR] 1.160, 95% Confidence Interval [CI] 0.553-2.434, P = 0.693). Procedure-related complications included facial numbness in 28.3% of MVD patients and 88.2% of PBC patients (P < 0.001), with bothersome numbness (BNI ≥ III) reported in 9.3% and 26.0%, respectively (P < 0.001). New or worsening masticatory dysfunction was observed in 2.2% of the MVD group compared to 7.9% of the PBC group (P = 0.011). No permanent neurological deficits or mortality occurred in either cohort.MVD offers durable pain relief with minimal sensory morbidity, while PBC achieves comparable pain relief at the cost of a significantly higher incidence of facial numbness. Treatment selection requires balancing efficacy, complications (particularly sensory side effects), and invasiveness.