Comparison of stereotactic radiosurgery and rhizotomy for trigeminal neuralgia: A systematic review and Meta-Analysis

OBJECTIVE: Trigeminal neuralgia (TN) is a chronic, debilitating neuropathy characterized by sudden, severe facial pain, often refractory to medical therapy. When medications fail, surgical options such as microvascular decompression (MVD) are preferred, but for patients unsuitable for open surgery, stereotactic radiosurgery (SRS) and percutaneous rhizotomy are viable alternatives. This systematic review and meta-analysis aimed to compare the efficacy and safety of SRS and rhizotomy in the management of TN. METHODS: Following PRISMA guidelines, PubMed, Embase, Scopus, and Web of Science were searched up to September 2024 for studies comparing SRS and rhizotomy in TN patients. Eligible studies reported pain relief, recurrence, retreatment rates, or complications. Data were extracted and analyzed using a random-effects model, with subgroup analyses for multiple sclerosis (MS) status. RESULTS: Fifteen studies involving 1,251 patients (577 SRS, 674 rhizotomy) were included. Rhizotomy provided superior initial pain-free outcomes (RR = 0.66, 95%CI = 0.49 ;0.91, p < 0.01), while SRS showed no significant difference in pain-free rates at the last follow-up (RR = 0.99, 95%CI = 0.80 ;1.22, p = 0.89) or overall pain relief (RR = 1.14, 95%CI = 0.90 ;1.44, p = 0.29). SRS significantly reduced recurrence (RR = 0.70, 95%CI = 0.51 ;0.96, p < 0.05), retreatment need (RR = 0.67, 95%CI = 0.46 ;0.96, p < 0.05), and facial numbness (RR = 0.61, 95%CI = 0.37 ;0.99, p < 0.05). Overall complications were comparable (RR = 0.70, 95%CI = 0.34 ;1.43, p = 0.33), though SRS trended toward fewer complications in MS patients. CONCLUSION: Rhizotomy provides immediate pain relief, making it suitable for patients requiring rapid results, while SRS offers greater durability and lower morbidity. Treatment choices should be tailored to patient-specific factors, including the urgency of relief and MS status. Future prospective studies with standardized outcomes and extended follow-up are needed to address the limitations of retrospective data and study heterogeneity.