Safety and efficacy of purely endoscopic microvascular decompression for trigeminal neuralgia: systematic review and single arm meta-analysis

Abstract

Microscopic microvascular decompression(M-MVD) is considered the gold standard treatment for primary trigeminal neuralgia and presents excellent long-term pain control rates. Despite the effectiveness of M-MVD, the use of endoscopy in these procedures has proven to be a promising approach. To evaluate the safety and efficacy of purely endoscopic microvascular decompression (E-MVD). A systematic review of the literature was performed using the PubMed, Scopus, Embase, and Cochrane databases. The primary outcome was satisfactory pain relief in short-term (0-30 days), mid-term (mean follow-up >/= 12 months) and long-term (mean follow-up >/= 24 months). Secondary outcomes were CSF leak, facial weakness, hearing loss, facial numbness, the rate of intraoperative identification of the offending vessel(s), mortality, length of stay and operative time. Inclusion criteria were studies including only patient submitted to E-MVD. Exclusion were secondary trigeminal neuralgia and mean follow-up < 12 months. Statistical analysis was performed using RStudio 2024.04.1 + 748. Heterogeneity was assessed using I² statistics. Sensitivity analysis was performed with leave-one-out test. Thirteen articles met the inclusion criteria, comprising a total of 1336 patients. Patients submitted to E-MVD had mean satisfactory pain relief rates of 92.93% (95% CI: 89.52-96.34% I2 = 86%), 88.54% (95% CI: 83.73-93.54% I2 = 87%) and 83.38% (95% CI: 76.58-90.17% I2 = 83%) in the short-term, mid-term and long-term follow-ups, respectively. Furthermore, the incidence of postoperative complications was low, including CSF leak (1.29% (95% CI: 0.32-2.26% I2 = 20%)), facial weakness (0.50% (95% CI: 0.00-1.79% I2 = 60%)), hearing loss (0.81% (95% CI: 0.05-1.57% I2 = 7%)) and facial numbness (3.84% (95% CI: 1.95-6.20% I2 = 54%)). There was no mortality related to the procedure (0% (95% CI: 0-0%; I2 = 0%)). The offending vessel(s) were identified in 99.57% of the cases (95% CI: 98.17-100.00% I2 = 67%)). Our meta-analysis revealed that E-MVD is a safe and effective procedure for the treatment of primary trigeminal neuralgia. Further studies are necessary to compare its usefulness to the traditional M-MVD approach.