Endoscopic Microvascular Decompression versus Microscopic Microvascular Decompression for Trigeminal Neuralgia: A Meta-Analysis of 612 Patients

Trigeminal neuralgia (TN) is a chronic pain condition related to trigeminal nerve compression. Microvascular decompression (MVD) is the standard of care for drug-resistant TN, performed using either microscopic (M-MVD) or endoscopic (E-MVD). The relative effectiveness and safety of both surgical modalities remain controversial. This meta-analysis aims to compare E-MVD and M-MVD regarding efficacy, safety, and postoperative complications. We conducted a comprehensive database search for studies comparing E-MVD and M-MVD. The primary outcome was pain relief. Secondary outcomes included operation time and postoperative complications. Pooled risk ratios (RR) and mean differences (MD) were calculated using a random-effects model. Six cohort studies met the inclusion criteria. There was no difference in rates of pain relief at 2 weeks (RR: 1.03, 95% CI: 0.97–1.09; p: 0.4) or 12 months postoperatively (RR: 1.02, 95% CI: 0.94–1.11, p: 0.60). There was no significant difference in operative time (SMD: 0.23, 95% CI: −0.04 to 0.49, p: 0.09). There was no difference in rates of hearing loss (RR: 0.91, 95% CI: 0.35–2.33, p: 0.84), facial numbness (RR: 0.86, 95% CI: 0.51–1.46, p: 0.57), or cerebrospinal fluid leaks (RR: 0.87, 95% CI: 0.15–4.92, p: 0.87). However, E-MVD showed a lower incidence of postoperative headaches (RR: 0.45, 95% CI: 0.21–0.96, p: 0.04). Both E-MVD and M-MVD provide effective pain relief for TN, with similar operative times and rates of pain relief. However, E-MVD was linked to a lower rate of postoperative headaches. Our findings indicate that both surgical modalities offer similar efficacy and safety. Larger multicenter studies are needed to understand the benefits of each technique and to guide personalized surgical decision-making for TN treatment.