Microvascular decompression versus percutaneous balloon compression for trigeminal neuralgia: a systematic review and meta-analysis of double-arm studies

Trigeminal neuralgia (TN) causes disabling facial pain often refractory to medication. Microvascular decompression (MVD) and percutaneous balloon compression (PBC) are established surgical options, yet their comparative efficacy and safety remain debated. Following PRISMA guidelines, a systematic review and meta-analysis of 19 double-arm studies (2,674 patients; 1486 MVD, 1188 PBC) was performed. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were computed. Evidence certainty was graded via GRADE. MVD and PBC achieved similar initial complete pain relief (RR = 1.01, 95% CI 0.98–1.05, <i>p</i> = 0.49) and adequate relief (RR = 1.00, 95% CI 0.97–1.02, <i>p</i> = 0.67). Long-term complete (RR = 1.11, 95% CI 0.97–1.27, <i>p</i> = 0.13) and adequate relief (RR = 1.06, 95% CI 0.97–1.15, <i>p</i> = 0.17) were likewise equivalent. Pain recurrence modestly favored MVD (RR = 0.72, 95% CI 0.51–1.00, <i>p</i> = 0.05), while permanent complications did not differ (RR = 1.09, 95% CI 0.43–2.75, <i>p</i> = 0.86). Leave-one-out analyses confirmed robustness, and Egger’s tests showed no publication bias. GRADE rated certainty high for initial relief, moderate for long-term outcomes and recurrence, and low for complications. MVD and PBC yield equivalent short-term and long-term pain relief, as well as similar safety, in TN. MVD may offer slightly lower recurrence, whereas PBC remains advantageous for elderly or medically fragile patients. These data support the use of tailored surgical selection guided by patient comorbidity and durability expectations.

三叉神经痛（Trigeminal neuralgia, TN）可引发致残性面部疼痛，且常对药物治疗抵抗。微血管减压术（Microvascular decompression, MVD）与经皮球囊压迫术（Percutaneous balloon compression, PBC）是临床已确立的外科治疗方案，但二者的比较疗效与安全性仍存在广泛争议。本研究遵循PRISMA指南，纳入19项双臂研究（共2674例患者，其中MVD组1486例、PBC组1188例）开展系统综述与Meta分析。研究计算了合并风险比（RRs）及95%置信区间（CIs），并通过GRADE系统对证据确定性进行分级。

MVD与PBC的初始完全疼痛缓解率相当（RR=1.01，95%CI 0.98~1.05，*p*=0.49），充分疼痛缓解率亦无显著统计学差异（RR=1.00，95%CI 0.97~1.02，*p*=0.67）。长期完全疼痛缓解（RR=1.11，95%CI 0.97~1.27，*p*=0.13）与长期充分疼痛缓解（RR=1.06，95%CI 0.97~1.15，*p*=0.17）同样无统计学差异。疼痛复发率方面MVD略占优势（RR=0.72，95%CI 0.51~1.00，*p*=0.05），而永久性并发症发生率组间无显著差异（RR=1.09，95%CI 0.43~2.75，*p*=0.86）。逐一剔除法分析证实研究结果稳健，Egger检验未发现存在发表偏倚。GRADE系统将初始缓解的证据确定性评为高级，长期结局与复发的证据确定性评为中级，并发症相关证据确定性评为低级。

TN患者接受MVD与PBC治疗后，短期与长期疼痛缓解效果及安全性均相当；MVD或可略微降低疼痛复发风险，而PBC则更适用于老年或身体状况不耐受复杂手术的患者。本研究数据支持根据患者合并症与疗效预期制定个体化外科治疗方案。