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. 2017 Jan 26;9(1):e1000.
doi: 10.7759/cureus.1000.

Microvascular Decompression Versus Stereotactic Radiosurgery for Trigeminal Neuralgia: A Decision Analysis

Ian Berger  1 , Nikhil Nayak  2 , James Schuster  2 , John Lee  2 , Sherman Stein  2 , Neil R Malhotra  2
Affiliations

Microvascular Decompression Versus Stereotactic Radiosurgery for Trigeminal Neuralgia: A Decision Analysis

Ian Berger et al. Cureus. .

Abstract

Introduction: Both microvascular decompression (MVD) and stereotactic radiosurgery (SRS) have been demonstrated to be effective in treating medically refractory trigeminal neuralgia. However, there is controversy over which one offers more durable pain relief and the patient selection for each treatment. We used a decision analysis model to calculate the health-related quality of life (QOL) for each treatment.

Methods: We searched PubMed and the Cochrane Database of Systematic Reviews for relevant articles on MVD or SRS for trigeminal neuralgia published between 2000 and 2015. Using data from these studies, we modeled pain relief and complication outcomes and assigned QOL values. A sensitivity analysis using a Monte Carlo simulation determined which procedure led to the greatest QOL.

Results: MVD produced a significantly higher QOL than SRS at a seven-year follow-up. Additionally, MVD patients had a significantly higher rate of complete pain relief and a significantly lower rate of complications and recurrence.

Conclusions: With a decision-analytic model, we calculated that MVD provides more favorable outcomes than SRS for the treatment of trigeminal neuralgia.

Keywords: cyberknife; decision analysis; gamma knife; microvascular decompression; radiosurgery; trigeminal neuralgia.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Outcomes of the Surgical Treatment of Trigeminal Neuralgia
Decision tree outlining the possible pathways encountered by a patient undergoing either SRS or MVD for trigeminal neuralgia. Note that because of the very large number of branches contained in the entire tree, we only display outcomes of a single procedure, free of complications. The tree shown is repeated for cases in which complications occur, and this larger tree is repeated for the other procedure. The aggregate tree is then populated with the probability of each branch and the effect on quality of life for each outcome.
Figure 2
Figure 2. Articles Reviewed
Summary of abstracts and articles reviewed for this report. Reasons for the rejection of case series are shown.
Figure 3
Figure 3. Complications of MVD Treatment
Sub-tree outlining complications reported after MVD for trigeminal neuralgia.
Figure 4
Figure 4. Complications of SRS Treatment
Sub-tree outlining complications reported after SRS for trigeminal neuralgia. Populating the tree with the probability and utility associated with each complication permits calculation of expected utility in patients who suffer complications after SRS.
Figure 5
Figure 5. Outcomes of Medical Treatment
Sub-tree for calculating the expected utility of taking maintenance medication.
See this image and copyright information in PMC

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