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  • Endoscopic Versus Open Microvascular Decompression (MVD) of Trigeminal Neuralgia: A Systematic Review and Comparative Meta-Analysis

    Final Number:

    Nirmeen Zagzoog MSc MD; Ahmed Attar; Radwan iBRAHIM Takroni MBBS; Mazen Alotaibi; Kesava (Kesh) Reddy

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Microvascular decompression (MVD) is commonly used in the treatment of trigeminal neuralgia with positive clinical outcomes. Fully endoscopic microvascular decompression (E-MVD) has been proposed as a minimally invasive, effective alternative, but a comparative review of the two approaches in the literature has not been conducted. We performed a meta-analysis comparing patient outcome rates and complications for the open versus endoscopic technique.

    Methods: From a pool of 1,039 studies, 22 articles, each with sample size greater than 30 patients were selected for review: 12 traditional MVD and 10 E-MVD. The total number of patients was 6,734 of which 5768 patients (and 5787 procedures) were MVD and 966 patients and procedures were E-MVD. Data analyzed included postoperative pain relief outcome (complete or good pain relief versus partial or no pain relief), and rates of recurrence and complications, including facial paralysis, weakness, or paresis; hearing loss; auditory and facial nerve damage; cerebrospinal fluid leak, infection; cerebellar damage; and mortality.

    Results: Good pain relief was achieved in 81% of MVD and 88% of E-MVD patients, with a mean recurrence rate of 14% and 9% respectively. Average rates of complications reported in MVD versus E-MVD approaches included facial paresis or weakness, 9% versus 3%; hearing loss, 4% versus 1%; cerebrospinal leak, both 3%; cerebellar damage and infection, 2% versus less than 1%; and mortality, less than 1% versus 0% respectively. Overall incidence of complications was 19% for MVD and 9% for E-MVD.

    Conclusions: The reviewed literature revealed similar clinical outcomes with respect to pain relief for MVD and E-MVD. Recurrence rate and incidence of complications, notably facial paresis and hearing loss were higher for MVD than E-MVD. Based on these results, use of endoscopy to perform microvascular decompression for trigeminal neuralgia appears to offer at least as good a surgical outcome as the more commonly used MVD, with the possible added advantages of having a shorter operative time, smaller craniectomy and lower recurrence rates. The authors advise caution in interpreting this data given the asymmetry in the sample size between the two groups at the moment and the relative novelty of the E-MVD approach.

    Patient Care: This systematic review and meta-analysis shows the difference in outcome and complication rates between the two surgical approaches, which will further help in making the decision on the preferred surgical technique.

    Learning Objectives: 1- To compare traditional method for MVD versus minimally invasive MVD. 2- To compare the complication rates between the two techniques. 3- To examine the difference in outcomes between the two surgical approaches.


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