Zachary S Mendelson1, Jayant R Velagala1, Gurkirat Kohli1, Gary M Heir2, Antonios Mammis1, James K Liu3. 1. Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA. 2. Division of Temporomandibular Disorders and Orofacial Pain, Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Newark, New Jersey, USA. 3. Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA; Center for Skull Base and Pituitary Surgery, Rutgers Neurological Institute of New Jersey, Newark, New Jersey, USA. Electronic address: james.liu.md@rutgers.edu.
Abstract
OBJECTIVE: Treatment options for trigeminal neuralgia include microvascular decompression (MVD) and Gamma Knife surgery (GKS). There is no consensus which option is more effective at providing immediate and long-lasting pain relief. This study evaluated the differences between these 2 options in terms of rates of complete pain relief and pain-free recurrence. METHODS: A systematic review was conducted of published studies of MVD and GKS for treatment of trigeminal neuralgia from 2004 to 2014. Studies were selected using a MEDLINE/PubMed search and from subsequent inspection of references from articles found in the initial search. Common outcome measures reported in the studies were used for meta-analysis to make conclusions based on current available data. RESULTS: The MVD group included 18 articles with 2650 patients, and the GKS group included 25 articles with 2846 patients. MVD was found to have a significantly higher rate of initial pain-free outcomes (Barrow Neurological Institute grade I) compared with GKS (92.22% vs. 61.46%, P < 0.0001). MVD was also found to have a significantly higher rate of long-term pain-free outcomes at last follow-up compared with GKS (79.37% vs. 41.62%, P < 0.0001). MVD was found to have a similar rate of pain-free recurrence compared with GKS (14.93% vs. 19.38%, P = 0.2536). CONCLUSIONS: MVD may be a more effective intervention than GKS owing to higher rates of initial pain-free outcomes and long-term pain-free outcomes. There is a need for more consistent data reporting of outcomes for treatment of trigeminal neuralgia.
OBJECTIVE: Treatment options for trigeminal neuralgia include microvascular decompression (MVD) and Gamma Knife surgery (GKS). There is no consensus which option is more effective at providing immediate and long-lasting pain relief. This study evaluated the differences between these 2 options in terms of rates of complete pain relief and pain-free recurrence. METHODS: A systematic review was conducted of published studies of MVD and GKS for treatment of trigeminal neuralgia from 2004 to 2014. Studies were selected using a MEDLINE/PubMed search and from subsequent inspection of references from articles found in the initial search. Common outcome measures reported in the studies were used for meta-analysis to make conclusions based on current available data. RESULTS: The MVD group included 18 articles with 2650 patients, and the GKS group included 25 articles with 2846 patients. MVD was found to have a significantly higher rate of initial pain-free outcomes (Barrow Neurological Institute grade I) compared with GKS (92.22% vs. 61.46%, P < 0.0001). MVD was also found to have a significantly higher rate of long-term pain-free outcomes at last follow-up compared with GKS (79.37% vs. 41.62%, P < 0.0001). MVD was found to have a similar rate of pain-free recurrence compared with GKS (14.93% vs. 19.38%, P = 0.2536). CONCLUSIONS: MVD may be a more effective intervention than GKS owing to higher rates of initial pain-free outcomes and long-term pain-free outcomes. There is a need for more consistent data reporting of outcomes for treatment of trigeminal neuralgia.