Meta-analysis Of Outcomes Related To Microscopic And Endoscopic Microvascular Decompression In The Treatment Of Primary Trigeminal Neuralgia

Objective:Meta-analysis was used to compare the outcomes of microscopic microvascular decompression(M-MVD)and endoscopic microvascular decompression(E-MVD)in the treatment of primary trigeminal neuralgia(PTN),and to evaluate the effects of different surgical methods,so as to provide some reference for the choice of clinical treatment.Methods:Retrieving the common databases by computer,which were Pub Med、MEDLINE、Web of Science、cochrane library 、EMBASE、CNKI、Sino Med,etc.The retrieval time of each database is from the establishment of the database to July 2021.The clinical controlled trials in the treatment of primary trigeminal neuralgia under microscope and neuroendoscope were selected in strict accordance with the inclusion and exclusion criteria,and the relevant data were extracted.Using the NOS scale to assess the quality of included studies.Finally,Meta-analysis of relevant outcomes was carried out by Rev Man5.3 software.Results:A total of 9 studies were included.The meta-analysis showed that compared with the control group(M-MVD),E-MVD has statistical difference in short-term remission(P = 0.01,95% CI: 1.12-2.61,OR = 1.71),total complications(P < 0.00001,95% CI: 0.30-0.56,OR = 0.41),cranial nerve effects(P = 0.0008,95% CI: 0.33-0.75,OR= 0.50),facial paralysis(P = 0.05,95% CI: 0.04-0.99,OR = 0.20)and recurrence(P = 0.009,95% CI: 0.11-0.73,OR = 0.28),suggesting that E-MVD is better than M-MVD in the treatment of PTN,with less postoperative complications,less influence on cranial nerve,lower occurence of facial paralysis and postoperative recurrence rate,and there was no statistical difference in long-term remission(P =0.43,95% CI: 0.67-2.60,OR = 1.32),cerebrospinal fluid leakage(P = 0.10,95% CI:0.10-1.22,OR = 0.36),hearing impairment(P = 0.09,95%CI: 0.24-1.11,or = 0.51),facial numbness(P = 0.06,95% CI: 0.39-1.01,OR = 0.63)and herpes(P=0.51,95%CI: 0.47-1.45,OR=0.83.It can not be considered that there are differences between the two operations in long-term remission,cerebrospinal fluid leakage,hearing impairment,facial numbness and herpes.In addtion,there is heterogeneity between studies in terms of operation time,under the random effect model,finding no statistical significance between E-MVD and M-MVD(P = 0.99,95% CI:-17.58-17.78,MD = 0.10).Excluding the literature with the greatest heterogeneity,there is homogeneity between studies,under the fixed effect model,obtaining statistical significance between E-MVD and M-MVD(P = 0.02,95% CI: 1.38-14.90,MD = 8.14).It is considered that the operation time of M-MVD is shorter than E-MVD.Conclusion:This study shows that in the decompression treatment of PTN,compared with M-MVD,E-MVD has higher short-term remission rate,less postoperative complications,less impact on cranial nerve,lower occurence of facial paralysis and postoperative recurrence rate.In terms of operation time,due to the heterogeneity between studies,excluding the literature with the greatest heterogeneity,the conclusion that the operation time of M-MVD is less than E-MVD is unstable.