Microvascular decompression for trigeminal neuralgia secondary to vertebrobasilar dolichoectasia: a systematic review and meta-analysis

BACKGROUND: Trigeminal neuralgia (TN) caused by vertebrobasilar dolichoectasia (VBD) is a rare but particularly challenging entity. Microvascular decompression (MVD) is considered the most definitive treatment; however, outcomes in this subgroup remain incompletely characterized. METHODS: We conducted a systematic review and meta-analysis following PRISMA guidelines. PubMed, Embase, Scopus, and Web of Science were searched from inception through August 22, 2025. Eligible studies reported on patients with VBD-TN undergoing MVD with extractable data on pain outcomes, recurrence, salvage interventions, or complications. Complete relief was defined as Barrow Neurological Institute (BNI)-I, while adequate relief included BNI-I to IIIb. RESULTS: Thirteen studies involving 315 patients were analyzed. The mean age ranged from 54.0 to 67.3 years, with 57.8% (182/315) being males. The pooled initial complete pain relief rate was 95.8% (95% CI, 92.3-98.2), with sustained relief at the last follow-up in 92.6% (95% CI, 88.4-96.1). Adequate relief was nearly universal, at 99.9% (95% CI, 98.2-100%) initially and 95.9% (95% CI, 91.8-98.8%) at the last follow-up. Pain recurrence occurred in 5.5% (95% CI, 2.9-8.9%), and salvage procedures were required in 1.3% (95% CI, 0.2-3.1%). The permanent morbidity was low at 2.4% (95% CI, 0.8-4.8%). Meta-regression indicated that prior ablative procedures were associated with higher complication rates, whereas V2 involvement predicted better long-term pain control. CONCLUSION: MVD appears to provide effective and durable pain relief for selected patients with VBD-TN, with low permanent morbidity but a clinically meaningful overall complication burden. Given the retrospective nature of the available evidence, MVD should be considered a promising treatment option rather than a definitive standard of care.