SynthesisNeurosurgical review2026
From microvascular decompression to radiosurgery: a network meta-analysis of interventions for medication-refractory trigeminal neuralgia.
Synthesis in Neurosurgical review, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionTrigeminal neuralgia (TN) is a chronic, debilitating neuropathy characterized by sudden, severe facial pain. Given the variety of available procedural options, we performed a systematic review and network meta-analysis to compare the relative efficacy and safety of interventions for medication-refractory TN, primarily based on observational evidence.
methodsWe conducted a systematic review and network meta-analysis registered in PROSPERO (CRD420251163324). PubMed, Embase, and CENTRAL were searched from inception to July 2025. A frequentist random-effects network meta-analysis was performed, estimating risk ratios (RRs) with 95% confidence intervals (CIs) for binary outcomes.
resultsEleven studies comprising 10,741 patients were included, evaluating microvascular decompression (MVD), percutaneous procedures (PP), Gamma Knife Surgery (GKS), and combined MVD + PP. Compared with MVD, GKS was associated with a lower risk of complications (RR 0.24; 95% CI 0.11–0.52), followed by PP (RR 0.34; 95% CI 0.12–0.93), whereas MVD + PP showed higher complication rates (RR 4.27; 95% CI 1.18–15.46). For complete pain relief (BNI I), combined MVD + PP showed a trend toward higher success (RR 1.18; 95% CI 0.72–1.93), while GKS was associated with lower rates (RR 0.52; 95% CI 0.39–0.70). For poor outcomes (BNI IV–V), estimates for MVD + PP were imprecise (RR 0.55; 95% CI 0.13–2.21), whereas higher risks were observed with GKS (RR 2.65; 95% CI 1.17–5.98) and PP (RR 3.73; 95% CI 0.68–20.64). Recurrence tended to be lower with MVD + PP (RR 0.66; 95% CI 0.21–2.12), while higher risks were observed with GKS (RR 3.14; 95% CI 1.43–6.85) and PP (RR 2.99; 95% CI 1.12–8.00). For facial numbness, stand-alone MVD showed the most favorable profile, whereas MVD + PP (RR 11.08; 95% CI 3.61–33.99) and PP (RR 3.69; 95% CI 1.92–7.09) were associated with higher risks.
conclusionsAmong patients with medication-refractory TN, different interventions exhibit distinct efficacy–safety trade-offs. While combined MVD + PP showed favorable pain-related trends, these findings are based on limited observational data and are accompanied by increased sensory morbidity. GKS demonstrated a favorable safety profile but with lower durability of pain control. Given the predominantly observational nature of the evidence and the low to very low certainty assessed by GRADE, these results should be interpreted cautiously and considered hypothesis-generating rather than practice-changing.
Indexed as
Identifiers
41793527What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.