Comparison On MVD And PRF For Trigeminal Neuralgia:a Systematic Review

Background：The etiology and pathogenesis of Trigeminal neuralgia at present not clear，although there are a variety of theories，but no one can explain to all sorts of trigeminal neuralgiamake perfect the etiology of explanation. 80% of the patients with trigeminal neuralgia instandard medical treatment can effectively control the pain，but it is difficult to cure and the sideeffects is great. Hence when drug treatment doesn’t satisfaction，the surgery is consider to use，such as microvascular decompression，percutaneous radiofrequency thermocoagulation，partialtrigeminal rhizotomy. Although the choose of surgical treatments has still big dispute，but thetherapeutic effect of long-term research shows that PRF and MVD are the true treatment. Forthese two kinds of surgical，there is still a lack of reliable systematic review to demonstrate theclinical effects and side effects at present.Objective：To collect the randomized and controlled clinical trials of the microvasculardecompression (MVD) and percutaneous radiofrequency thermocoagulation (PRF) intrigeminal neuralgia(TN) and make a systematic review to explore the exact clinical effects andsecurity so as to provide the best evidence in the clinical application.Material and Methods：According to the Cochrane book for systematic reviews，a fullyrecursive literature search was conducted in Cochrane Central Register，MEDLINE，CNKI andCBM of Controlled Trials in English and Chinese. By using a defined search strategy，both therandomized controlled trials (RCTs) and controlled clinical trials on comparing MVD with PRFin trigeminal neuralgia were identified. Two reviewers independently screened eligibilityinvolved these ten studies，evaluated the quality and extracted the data from the eligible studies.Meta-analyses were conducted using the Cochrane Collaboration’s software of RevMan 5.0.There was no heterogeneity if P>0.10 the multiple similar study were descripted homogeneity，data were pooled using fixed effect model；otherwise P≤0.1，we adopted sensitivity analysis，subgroup analysis or randomized effect model and would use qualitative analysis while the datacould not be pooled.Results：Ten controlled clinical trials were included. The results of meta-analysesshowed that：a)The pain relief rate：in MVD was higher than PRF with significant difference[OR=1.72，95%C（I1.17，2.52），P=0.006]；b)The recurrence rate of MVD was lower than PRF group with significant difference [OR=0.38，95%C（I0.18，0.79），P=0.01]；c)The complicationsrate in the MVD group was shorter than that of the PRF group with significantdifference[OR=0.38，95%CI（0.19，0.75），P=0.005].Conclusion：Currently evidence suggests that，the overall effect of MVD is better than PRFin more rapid pain relief，lower recurrence rate，fewer complications. For the influencing factorsof few samples and lower quality methodological samples，the system evaluation of persuasionreduces in a certain extent.