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Microvascular decompression for trigeminal neuralgia due to vertebrobasilar artery compression: a systematic review and meta-analysis

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Abstract

Trigeminal neuralgia (TN) caused by vertebrobasilar artery (VBA) compression is a rare event, reported between 2 and 6% (Linskey et al. J Neurosurg 81:1-9,1992, Vanaclocha et al.World Neurosurg 96:516-529,2016) of the time. Microvascular decompression (MVD) is advised for drug-resistant pain and, although technically challenging, is associated with an excellent outcome in current literature (Apra et al.Neurosurg Rev 40:577-582,2017, Cruccuet al. EurJ Neurol 15:1013-1028,2008, Linskey et al. J Neurosurg 81:1-9,1992). The authors performed a systematic review and meta-analysis of the literature examining the rate of MVD for trigeminal neuralgia caused by VBA compression and the post-operative outcome. The systematic search of three databases was performed for studies published between January 1990 and October 2020. Random-effects meta-analysis was used to pool the analyzed outcomes, and random-effects meta-regression was used to examine the association between the effect size and potential confounders. Funnel plot followed by Egger’s linear regression was used to test publication bias. We included 9 studies, and the overall rate of TN due to VBA compression was 3.4% (95% CI 2.5–4.3%, p < 0.01, I2 = 67.9%) among all MVD for TN. Immediately after surgery, 96% (p < 0.01, I2 = 0%) of patients were pain-free, and at last follow-up, approximately 93% (p < 0.01, I2 = 0%) of patients were classified as BNI I–II. Hearing impairment and facial numbness were the most common long-term complications ensuing MVD for VBA compression (5% and 13%, respectively). In conclusion, the surgical management of trigeminal neuralgia caused by VBA compression is associated with good outcome and low rate of post-operative complications. Further studies are needed to analyze the long-term results and the rate of pain recurrence among this population.

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Acknowledgements

We thank Prof. Beth De Felici for the English revision.

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Authors and Affiliations

  1. Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Via Paradisa 2, 56100, Pisa, Italy

    Davide Tiziano Di Carlo, Nicola Benedetto, Walter Marani, Nicola Montemurro & Paolo Perrini

  2. Department of Translational Research On New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy

    Davide Tiziano Di Carlo & Paolo Perrini

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  1. Davide Tiziano Di Carlo
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Contributions

DTDC, PP, and WM contributed to the study conception and design. DTDC, WM, and NM performed literature search, collection, screening, and analysis. DTDC, NB, and PP interpreted the results and assessed the risk of bias. DTDC wrote the draft of the manuscript. All authors critically reviewed, commented, and approved the final manuscript.

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Correspondence to Davide Tiziano Di Carlo.

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Di Carlo, D.T., Benedetto, N., Marani, W. et al. Microvascular decompression for trigeminal neuralgia due to vertebrobasilar artery compression: a systematic review and meta-analysis. Neurosurg Rev 45, 285–294 (2022). https://doi.org/10.1007/s10143-021-01606-1

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