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Glossopharyngeal neuralgia treatment outcomes following nerve section, microvascular decompression, or stereotactic radiosurgery: a systematic review and meta-analysis

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Authors: Lu V j et al

World Neurosurgery (Sep 2018)

BACKGROUND Glossopharyngeal neuralgia (GPN) is a rare neuralgic pain syndrome amenable to neurosurgical treatments including nerve section (NS), microvascular decompression (MVD), and stereotactic radiosurgery (SRS). However, thorough comparisons between the modalities have not been performed to date. The objective of this study was to compare the pain and complication outcomes following these approaches to GPN.

METHODS Searches of 7 electronic databases from inception to June 2018 were conducted following appropriate guidelines. Incidence rates (IRs) of short- (≤ 3 months) and long-term (≥12 months) pain relief, and complications, were extracted and analyzed by meta-analysis. Meta-regression was used to assess heterogeneity.

RESULTS 792 GPN cases managed by NS, MVD, or SRS were described by 6, 11, and 6 studies, reporting outcomes in 282 (36%), 446 (56%) and 67 (8%) cases. Short-term pain relief rate was highest following NS postoperatively (IR, 94%; 95% CI, 88-98%), and lowest after SRS by 3 months (IR, 80%; 95% CI, 68-96%). Postoperative complications rate was highest after MVD (IR, 26%; 95% CI, 16-38%), and lowest after SRS (IR, 0%; 95% CI, 0-4%). Long-term pain relief rate was highest after NS (IR, 96%; 95% CI, 91-99%), and lowest after SRS (IR, 82%; 95% CI, 67-94%). Statistical differences between approaches were significant for each outcome.

CONCLUSION Neurosurgical treatment of GPN is frequently performed by one of three modalities with unique outcomes profiles. NS may provide the most favorable treatment response, with respect to short-term and long-term pain relief, as well as postoperative outcomes.

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