Comparative safety and efficacy of percutaneous approaches for the treatment of trigeminal neuralgia: A systematic review and meta-analysis

Abstract Percutaneous treatments for trigeminal neuralgia (TN) include glycerol rhizotomy (GR), radiofrequency thermocoagulation (RF), and balloon compression (BC), which aim to provide pain relief by targeted injury to the trigeminal nerve pain fibers. All three techniques are well established and can provide immediate pain relief; however each of them can be associated with a range of complications. Our objective was to compare the safety and efficacy of GR, RF and BC in patients with TN. This study was performed according to the PRISMA guidelines. A random effects model meta-analysis was conducted. Fourteen studies were included. The comparisons of RF vs GR comprised 2,518 patients overall. RF was associated with statistically significant higher odds of immediate pain relief (OR: 2.65; 95% CI: 1.29–5.44; I 2 :85.5%) when compared to GR. Patients in the RF group had a statistically significant higher risk of anesthesia in the trigeminal distribution (OR: 4.73; 95% CI: 2.25–9.96; I 2 :0%) and lower risk for herpes eruption (OR: 0.30; 95% CI: 0.17–0.56; I 2 :0%). The comparison of BC vs GR included 961 patients. Patients in the BC group had a statistically significant higher risk of mastication weakness (OR: 9.29; 95% CI: 2.71–31.86; I 2 :0%) and diplopia due to CN IV or CN V palsy (OR: 6.31; 95% CI: 1.70-23.33; I 2 :0%) compared to patients in the GR group. The comparisons of BC vs RF comprised 3,183 patients and did not show significant differences between the two groups. RF is associated with statistically significant higher odds for immediate pain relief and anesthesia and lower risk for post-operative herpes eruption as compared to GR. Patients in the BC group had a statistically significant higher risk to develop post-operative mastication weakness and diplopia when compared to GR.