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

OBJECTIVE: Treatment options for trigeminal neuralgia include microvascular decompression (MVD) and Gamma Knife surgery (GKS). There is no consensus which option is more effective at providing immediate and long-lasting pain relief. This study evaluated the differences between these 2 options in terms of rates of complete pain relief and pain-free recurrence. METHODS: A systematic review was conducted of published studies of MVD and GKS for treatment of trigeminal neuralgia from 2004 to 2014. Studies were selected using a MEDLINE/PubMed search and from subsequent inspection of 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 current available data. RESULTS: The MVD group included 18 articles with 2650 patients, and the GKS group included 25 articles with 2846 patients. MVD was found to have a significantly higher rate of initial pain-free outcomes (Barrow Neurological Institute grade I) compared with GKS (92.22% vs. 61.46%, P < 0.0001). MVD was also found to have a significantly higher rate of long-term pain-free outcomes at last followup compared with GKS (79.37% vs. 41.62%, P < 0.0001). MVD was found to have a similar rate of pain-free recurrence compared with GKS (14.93% vs. 19.38%, P = 0.2536). CONCLUSIONS: MVD may be a more effective intervention than GKS owing to higher rates of initial pain-free outcomes and long-term pain-free outcomes. There is a need for more consistent data reporting of outcomes for treatment of trigeminal neuralgia.