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Introduction <p>Trigeminal neuralgia(TN) is a debilitating condition often requiring surgical intervention when medical therapy fails. Microvascular decompression (MVD) and Gamma Knife surgery (GKS) are the main treatment options, but their relative efficacy and safety remain debated. This meta-analysis aimed to compare outcomes between MVD and GKS in patients with TN.</p> Methods <p>We systematically searched PubMed, Embase, and Cochrane without temporal restrictions, in July 2025, for randomized controlled trials and observational studies that had as an intervention MVD versus GKS in patients with TN that reported any outcomes of interest as (1) Pain relief, (2) recurrence of pain; (3) numbness; (4) BNI score IV, V; (5) Overall complications. Statistical analyses were performed using R software.</p> Results <p>A total of eight studies comprising 8.444 patients were included, of whom 6.831 (80.9%) underwent MVD. In the pooled analysis, MVD was associated with higher rates of pain relief compared with GKS(RR 1.87, 95% CI [1.38–2.53], p &lt; 0.001, I² = 88.4%). Conversely, MVD was associated with a reduced risk of persistent or severe pain (BNI IV/V) (RR 0.65, 95% CI 0.52–0.81; p &lt; 0.001; I² = 0%) and lower recurrence of pain (RR 0.32, 95% CI 0.14–0.74; p = 0.008; I² = 79%). Regarding safety outcomes, MVD was linked to a higher risk of overall complications (RR 3.37, 95% CI 1.39–8.15; p = 0.007; I² = 82%) but a lower risk of postoperative numbness compared with GKS (RR 0.50, 95% CI 0.34–0.75; p &lt; 0.001; I² = 32%). </p> Conclusion <p>Both procedures appear effective in the management of TN. MVD was associated with higher rates of pain relief and lower recurrence, while GKS showed a more favorable overall complication profile but a higher risk of postoperative numbness. However, these findings should be interpreted with caution due to substantial heterogeneity across several outcomes and the observational nature of the included studies.</p>

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Efficacy and safety of microvascular decompression versus gamma knife surgery in patients with trigeminal neuralgia: an updated meta-analysis

  • 期刊论文

  • 发表日期：

    2026年7月8日

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  • Pandora E. O Fonseca,
  • Bárbara F. Bonatti,
  • Helen M. de Oliveira,
  • Wellgner Fernandes Oliveira Amador,
  • Davi R. S. G. Amorim,
  • Renata T. Fernandes,
  • Afonso Dutra-Melo

摘要

Introduction

Trigeminal neuralgia(TN) is a debilitating condition often requiring surgical intervention when medical therapy fails. Microvascular decompression (MVD) and Gamma Knife surgery (GKS) are the main treatment options, but their relative efficacy and safety remain debated. This meta-analysis aimed to compare outcomes between MVD and GKS in patients with TN.

Methods

We systematically searched PubMed, Embase, and Cochrane without temporal restrictions, in July 2025, for randomized controlled trials and observational studies that had as an intervention MVD versus GKS in patients with TN that reported any outcomes of interest as (1) Pain relief, (2) recurrence of pain; (3) numbness; (4) BNI score IV, V; (5) Overall complications. Statistical analyses were performed using R software.

Results

A total of eight studies comprising 8.444 patients were included, of whom 6.831 (80.9%) underwent MVD. In the pooled analysis, MVD was associated with higher rates of pain relief compared with GKS(RR 1.87, 95% CI [1.38–2.53], p < 0.001, I² = 88.4%). Conversely, MVD was associated with a reduced risk of persistent or severe pain (BNI IV/V) (RR 0.65, 95% CI 0.52–0.81; p < 0.001; I² = 0%) and lower recurrence of pain (RR 0.32, 95% CI 0.14–0.74; p = 0.008; I² = 79%). Regarding safety outcomes, MVD was linked to a higher risk of overall complications (RR 3.37, 95% CI 1.39–8.15; p = 0.007; I² = 82%) but a lower risk of postoperative numbness compared with GKS (RR 0.50, 95% CI 0.34–0.75; p < 0.001; I² = 32%).

Conclusion

Both procedures appear effective in the management of TN. MVD was associated with higher rates of pain relief and lower recurrence, while GKS showed a more favorable overall complication profile but a higher risk of postoperative numbness. However, these findings should be interpreted with caution due to substantial heterogeneity across several outcomes and the observational nature of the included studies.