Pain-Free outcomes and Durability of Surgical Intervention for Trigeminal Neuralgia: A Comparison of Gamma Knife and Microvascular Decompression.

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Pain-Free outcomes and Durability of Surgical Intervention for Trigeminal Neuralgia: A Comparison of Gamma Knife and Microvascular Decompression.

World Neurosurg. 2018 Jan 27;:

Authors: Mendelson ZS, Velagala JR, Kohli G, Heir GM, Mammis A, Liu JK

Abstract
OBJECTIVE: Procedural options for trigeminal neuralgia (TN) include microvascular decompression (MVD) and gamma knife surgery (GKS). Currently, there is no definitive consensus as to which of the two options is more effective at providing immediate and long-lasting pain relief. This study seeks to better evaluate the differences between these two options in terms of rates of complete pain relief and pain-free recurrence METHODS: A systematic review was conducted on published studies of MVD and GKS for treatment of TN from 2004 to 2014. Cases were selected using a MEDLINE/PubMED search, as well as, from subsequent inspection of the 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 the current available data.
RESULTS: Eighteen articles with a total of 2,650 patients were included in the MVD group while 25 articles with a total of 2,846 patients were included in the GKS group. MVD was found to have a significantly higher rate of initial pain-free outcomes (BNI grade I) as compared to GKS (92.22% vs. 61.46%, P<0.0001). Additionally, MVD was also found to have a significantly higher rate of long-term pain-free outcomes at last follow-up as compared to GKS (79.37% vs. 41.62%, P<0.0001). MVD was found to have a similar rate of pain-free recurrence as compared to GKS (14.93% vs. 19.38%, P=0.2536).
CONCLUSION: MVD may be a more effective intervention than GKS due to higher rates of initial pain-free outcomes and long-term pain-free outcomes. Additionally, there is a need for more consistent data reporting of outcomes for treatment of TN.

PMID: 29382615 [PubMed - as supplied by publisher]

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