Background: The success of repeat surgery for
recurrent trigeminal neuralgia (TN)—with microvascular decompression (MVD),
percutaneous rhizotomy (PR), or stereotactic radiosurgery (SRS)—is not
well-studied. We performed a systematic review and meta-analysis of the
literature on repeat surgery recurrent TN, focusing on the durability of
pain relief and relative efficacy of MVD, PR, and SRS.
Methods: A PRISMA systematic review of
Medline/Embase/Pubmed identified studies of adults with unilateral
idiopathic TN undergoing repeat surgery. The primary outcome of complete
pain relief (CPR) at last follow-up was analyzed with a multivariate
mixed-effects meta-analysis of proportions. Results:
Seventy-eight studies met criteria; 61 were included in meta-analyses,
containing 29/14/25 cohorts with 900/684/1353 patients undergoing MVD/PR/SRS
respectively (mean age 64.7 years, 41% males). Initial CPR was 69%
(74%/85%/52%). CPR at mean 39.7 month follow-up (38.3/38.8/41.0) was 48%
(59%/60%/34%). Initial CPR for both MVD (CPR: 0.78 [0.70-0.85]) and PR (CPR:
0.93 [0.83-0.98]) was superior to SRS (CPR: 0.48 [0.35-0.61]). At follow-up,
MVD (0.45 [0.32-0.58]) and PR (0.45 [0.30-0.60]) trended towards superior
CPR versus SRS (0.25 [0.15-0.37]). Conclusions: Half
of recurrent TN patients achieve good pain control 3 years after repeat
surgery. MVD/PR showed superior initial pain relief and likely better
long-term relief. These findings can inform surgical decision-making in this
challenging population.