Stereotactic Radiosurgery vs. Neuroablative Techniques for Medically Refractory Trigeminal Neuralgia: A Systematic Review and Meta Analysis of Outcomes.

Abstract

Background There is a lack of evidence to guide the choice between stereotactic radiosurgery (SRS) and neuroablative procedures for patients with medically refractory trigeminal neuralgia (TN). This meta-analysis aims to identify the outcomes of these interventions for TN. Methods Studies identified through PubMed, MEDLINE, and Embase, were cohort studies or clinical trials, had ≥20 participants, and had a ≥12-month follow-up. All participants were ≥16 years old and had primary refractory TN. Studies reported outcomes using the Barrow Neurological Institute (BNI) scale. The Shapiro-Wilk test, Mann-Whitney U test, two-tailed T Test, Spearman's R, and ANCOVA were used to test statistical significance. Screening was done according to PRISMA guidelines. Bias assessment was according to the Newcastle-Ottawa Scale. Results 3288 patients from 37 studies were included (2537 SRS, 751 neuroablative). Overall reporting of BNI I, II, III, IV, and V was 36.0%, 17.4%, 23.9%, 11.7%, and 10.9% respectively in the SRS cohort, and 63.6%, 10.4%, 11.1%, 7.3%, and 7.6% respectively in the neuroablative cohort (p<0.0001). Recurrence was 41.6% in the SRS cohort and 22.5% in the neuroablative cohort (p<0.001). The neuroablative cohort reported significantly higher rates of hypoesthesia (18.6% vs. 50.5%, p<0.0001), and minor (19.6% vs. 2.2%, p<0.0001) and major (3.4% vs. 1.3%, p<0.001) adverse effects compared to SRS. Conclusions The findings suggest improved pain relief and reduced recurrence with neuroablative procedures compared to SRS, albeit conferring a higher rate of adverse effects. Neuroablative techniques may be more appropriate for patients with medically refractory TN who are unsuitable for microvascular decompression.