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This systematic review and meta-analysis compared endoscopic (EN-MVD; n=465) and microscopic (MI-MVD; n=586) microvascular decompression in 10 studies including 1,051 patients with trigeminal neuralgia. Adequate pain relief was similar between the two approaches at all time points. EN-MVD was associated with higher long-term complete pain freedom (OR 2.72, P<0.01), lower recurrence (OR 0.51, P=0.02) and fewer overall complications (OR 0.48, P<0.001), driven mainly by less postoperative headache (OR 0.28, P<0.001); other complications were comparable. Multiple offending vessels were identified more often with the endoscope (OR 1.99, P=0.035). Operative time was about 6.4 minutes longer with EN-MVD, whereas decompression time was about 2.8 minutes shorter. Because the included studies were non-randomized and the certainty of evidence was low, the authors consider the findings hypothesis-generating and call for prospective, ideally randomized, multicentre studies.
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This systematic review and meta-analysis compared endoscopic (EN-MVD; n=465) and microscopic (MI-MVD; n=586) microvascular decompression in 10 studies including 1,051 patients with trigeminal neuralgia. Adequate pain relief was similar between the two approaches at all time points. EN-MVD was associated with higher long-term complete pain freedom (OR 2.72, P<0.01), lower recurrence (OR 0.51, P=0.02) and fewer overall complications (OR 0.48, P<0.001), driven mainly by less postoperative headache (OR 0.28, P<0.001); other complications were comparable. Multiple offending vessels were identified more often with the endoscope (OR 1.99, P=0.035). Operative time was about 6.4 minutes longer with EN-MVD, whereas decompression time was about 2.8 minutes shorter. Because the included studies were non-randomized and the certainty of evidence was low, the authors consider the findings hypothesis-generating and call for prospective, ideally randomized, multicentre studies.
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