{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T18:47:39Z","timestamp":1792176459310,"version":"4.4.0"},"reference-count":41,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,3,23]],"date-time":"2023-03-23T00:00:00Z","timestamp":1679529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Medical treatment for trigeminal neuralgia (TN) is not always a feasible option due to a lack of full response or adverse effects. Open surgery or percutaneous procedures are advocated in these cases. Several articles have compared the results among different techniques. Nevertheless, the findings of these studies are heterogeneous. Umbrella reviews are studies sitting at the peak of the evidence pyramid. With this umbrella review, we provided a systematic review of the outcomes of the surgical procedures used for TN treatment. Only systematic reviews and meta-analyses were included following the PRISMA guidelines. Ten articles were enrolled for qualitative and quantitative assessment. Level of evidence was quantified using a specific tool (AMSTAR-2). Results were heterogenous in terms of outcome and measurements. Microvascular decompression (MVD) appeared to be the most effective procedure both in the short-term (pain relief in 85\u201396.6% of cases) and long-term follow-up (pain relief in 64\u201379% of cases), although showed the highest rate of complications. The results of percutaneous techniques were similar but radiosurgery showed the highest variation in term of pain relief and a higher rate of delayed responses. The use of the AMSTAR-2 tool to quantify the evidence level scored three studies as critically low and seven studies as low-level, revealing a lack of good quality studies on this topic. Our umbrella review evidenced the need of well-designed comparative studies and the utilization of validated scales in order to provide more homogenous data for pooled-analyses and meta-analyses in the field of TN surgical treatment.<\/jats:p>","DOI":"10.3390\/brainsci13040530","type":"journal-article","created":{"date-parts":[[2023,3,24]],"date-time":"2023-03-24T03:16:46Z","timestamp":1679627806000},"page":"530","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Outcome Comparison of Drug-Resistant Trigeminal Neuralgia Surgical Treatments\u2014An Umbrella Review of Meta-Analyses and Systematic Reviews"],"prefix":"10.3390","volume":"13","author":[{"given":"Alessandro","family":"Rapisarda","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Battistelli","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Neurosurgery Section, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Izzo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuela","family":"D\u2019Ercole","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2953-9291","authenticated-orcid":false,"given":"Quintino Giorgio","family":"D\u2019Alessandris","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy"},{"name":"Department of Neuroscience, Neurosurgery Section, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo Maria","family":"Polli","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuele","family":"Santi","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Neurosurgery Section, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renata","family":"Martinelli","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Neurosurgery Section, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4965-1950","authenticated-orcid":false,"given":"Nicola","family":"Montano","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy"},{"name":"Department of Neuroscience, Neurosurgery Section, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"4425","DOI":"10.1007\/s10072-022-05971-7","article-title":"The Role of Biomarkers in Drug-Resistant Trigeminal Neuralgia: A Prospective Study in Patients Submitted to Surgical Treatment","volume":"43","author":"Rapisarda","year":"2022","journal-title":"Neurol. Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1111\/j.1468-1331.2008.02185.x","article-title":"AAN-EFNS Guidelines on Trigeminal Neuralgia Management","volume":"15","author":"Cruccu","year":"2008","journal-title":"Eur. J. Neurol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1007\/s10072-022-06573-z","article-title":"CSF neuron-specific enolase as a biomarker of neurovascular conflict severity in drug-resistant trigeminal neuralgia: A prospective study in patients submitted to microvascular decompression","volume":"44","author":"Baroni","year":"2023","journal-title":"Neurol. Sci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1111\/ene.13950","article-title":"European Academy of Neurology Guideline on Trigeminal Neuralgia","volume":"26","author":"Bendtsen","year":"2019","journal-title":"Eur. J. Neurol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1097\/XEB.0000000000000055","article-title":"Summarizing Systematic Reviews: Methodological Development, Conduct and Reporting of an Umbrella Review Approach","volume":"13","author":"Aromataris","year":"2015","journal-title":"Int. J. Evid. Based Healthc."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., Altman, D., Antes, G., Atkins, D., Barbour, V., Barrowman, N., and Berlin, J.A. (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med., 339.","DOI":"10.1136\/bmj.b2535"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2227","DOI":"10.1016\/j.joms.2021.03.003","article-title":"Does the Surgical Intervention for Trigeminal Neuralgia Refractory to Pharmacotherapy Improve Quality-of-Life?\u2014A Systematic Review","volume":"79","author":"Diana","year":"2021","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e732","DOI":"10.1016\/j.wneu.2018.01.141","article-title":"Pain-Free Outcomes and Durability of Surgical Intervention for Trigeminal Neuralgia: A Comparison of Gamma Knife and Microvascular Decompression","volume":"112","author":"Mendelson","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1227\/01.NEU.0000114867.98896.F0","article-title":"Systematic Review of Ablative Neurosurgical Techniques for the Treatment of Trigeminal Neuralgia","volume":"54","author":"Lopez","year":"2004","journal-title":"Neurosurgery"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"738032","DOI":"10.3389\/fneur.2021.738032","article-title":"Recurrence Rates After Microvascular Decompression in Patients With Primary Trigeminal Neuralgia and Its Influencing Factors: A Systematic Review and Meta-Analysis Based on 8,172 Surgery Patients","volume":"12","author":"Chen","year":"2021","journal-title":"Front. Neurol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1007\/s13760-021-01654-w","article-title":"Efficacy and Safety of Radiofrequency in the Treatment of Trigeminal Neuralgia: A Systematic Review and Meta-Analysis","volume":"122","author":"Yan","year":"2022","journal-title":"Acta Neurol. Belg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"688","DOI":"10.4103\/0028-3886.232342","article-title":"Microvascular Decompression versus Stereotactic Radiosurgery as Primary Treatment Modality for Trigeminal Neuralgia: A Systematic Review and Meta-Analysis of Prospective Comparative Trials","volume":"66","author":"Sharma","year":"2018","journal-title":"Neurol. India"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.jocn.2023.01.002","article-title":"Is percutaneous balloon compression better than microvascular decompression to treat trigeminal neuralgia? A systematic review and meta-analysis","volume":"109","author":"Nascimento","year":"2023","journal-title":"J. Clin. Neurosci."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.clineuro.2019.05.011","article-title":"Comparative Safety and Efficacy of Percutaneous Approaches for the Treatment of Trigeminal Neuralgia: A Systematic Review and Meta-Analysis","volume":"182","author":"Texakalidis","year":"2019","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1532","DOI":"10.3171\/2018.6.JNS172690","article-title":"Endoscopic versus Open Microvascular Decompression for Trigeminal Neuralgia: A Systematic Review and Comparative Meta-Analysis","volume":"131","author":"Zagzoog","year":"2019","journal-title":"J. Neurosurg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1080\/02688697.2018.1472213","article-title":"First Treatment and Retreatment of Medically Refractive Trigeminal Neuralgia by Stereotactic Radiosurgery versus Microvascular Decompression: A Systematic Review and Meta-Analysis","volume":"32","author":"Lu","year":"2018","journal-title":"Br. J. Neurosurg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"j4008","DOI":"10.1136\/bmj.j4008","article-title":"AMSTAR 2: A Critical Appraisal Tool for Systematic Reviews That Include Randomised or Non-Randomised Studies of Healthcare Interventions, or Both","volume":"358","author":"Shea","year":"2017","journal-title":"BMJ"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e113","DOI":"10.1016\/j.wneu.2018.04.120","article-title":"Efficacy and Safety of Microvascular Decompression and Gamma Knife Surgery Treatments for Patients with Primary Trigeminal Neuralgia: A Prospective Study","volume":"116","author":"Zeng","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1016\/j.wneu.2016.10.028","article-title":"Comparison of Percutaneous Retrogasserian Balloon Compression and Gamma Knife Radiosurgery for the Treatment of Trigeminal Neuralgia in Multiple Sclerosis","volume":"97","author":"Wolf","year":"2017","journal-title":"World Neurosurg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2127","DOI":"10.1007\/s00701-017-3325-7","article-title":"Long-Term Outcomes of Microvascular Decompression and Gamma Knife Surgery for Trigeminal Neuralgia: A Retrospective Comparison Study","volume":"159","author":"Inoue","year":"2017","journal-title":"Acta Neurochir."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"535","DOI":"10.2147\/JPR.S110161","article-title":"Efficacy of Stereotactic Gamma Knife Surgery and Microvascular Decompression in the Treatment of Primary Trigeminal Neuralgia: A Retrospective Study of 220 Cases from a Single Center","volume":"9","author":"Dai","year":"2016","journal-title":"J. Pain Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1016\/S0360-3016(03)00264-5","article-title":"Radiosurgical Treatment of Trigeminal Neuralgia: Evaluating Quality of Life and Treatment Outcomes","volume":"56","author":"Petit","year":"2003","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"747","DOI":"10.3340\/jkns.2017.0196","article-title":"Prospective Comparison of Redo Microvascular Decompression and Percutaneous Balloon Compression as Primary Surgery for Recurrent Trigeminal Neuralgia","volume":"61","author":"Chen","year":"2018","journal-title":"J. Korean Neurosurg. Soc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1227\/NEU.0000000000001059","article-title":"Percutaneous Balloon Compression vs. Percutaneous Retrogasserian Glycerol Rhizotomy for the Primary Treatment of Trigeminal Neuralgia","volume":"78","author":"Asplund","year":"2016","journal-title":"Neurosurgery"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1097\/00006123-199304000-00012","article-title":"Percutaneous Trigeminal Nerve Compression for Treatment of Trigeminal Neuralgia: Results in 50 Patients Clinical Study","volume":"32","author":"Brown","year":"1993","journal-title":"Neurosurgery"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"479","DOI":"10.3171\/jns.1983.59.3.0479","article-title":"Trigeminal Neuralgia Treated by Radiofrequency Coagulation","volume":"59","author":"Latchaw","year":"1983","journal-title":"J. Neurosurg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1097\/00002508-199612000-00010","article-title":"Neurosurgery for Trigeminal Neuralgia: Comparison of Alcohol Block, Neurectomy, and Radiofrequency Coagulation","volume":"12","author":"Oturai","year":"1996","journal-title":"Clin. J. Pain Issue"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/S0304-3959(98)00145-6","article-title":"A Prospective, Longitudinal Study on Patients with Trigeminal Neuralgia Who Underwent Radiofrequency Thermocoagulation of the Gasserian Ganglion","volume":"79","author":"Zakrzewska","year":"1999","journal-title":"Pain"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/0304-3959(89)90066-3","article-title":"Percutaneous procedures for trigeminal neuralgia: Microcompression versus radiofrequency thermocoagulation. Personal experience","volume":"38","author":"Meglio","year":"1989","journal-title":"Pain"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1623","DOI":"10.1007\/s00701-021-04793-4","article-title":"Comparison of First-Time Microvascular Decompression with Percutaneous Surgery for Trigeminal Neuralgia: Long-Term Outcomes and Prognostic Factors","volume":"163","author":"Noorani","year":"2021","journal-title":"Acta Neurochir."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"851","DOI":"10.3171\/jns.1990.72.6.0851","article-title":"Percutaneous Retrogasserian Glycerol Rhizotomy Predictors of Success and Failure in Treatment of Trigeminal Neuralgia","volume":"72","author":"North","year":"1990","journal-title":"J. Neurosurg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1007\/BF01405534","article-title":"Long-term results after percutaneous retrogasserian glycerol rhizotomy in patients with trigeminal neuralgia","volume":"122","author":"Hirschberg","year":"1993","journal-title":"Acta Neurochir."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1136\/jnnp.2003.018564","article-title":"Stereotactic Radiosurgery for Primary Trigeminal Neuralgia: State of the Evidence and Recommendations for Future Reports","volume":"75","author":"Lopez","year":"2004","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/S0002-9610(34)90403-7","article-title":"Concerning the cause of trigeminal neuralgia","volume":"24","author":"Dandy","year":"1934","journal-title":"Am. J. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"947","DOI":"10.3171\/jns.1962.19.11.0947","article-title":"Concerning the mechanism of trigeminal neuralgia and hemifacial spasm","volume":"19","author":"Gardner","year":"1962","journal-title":"J Neurosurg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"159","DOI":"10.3171\/jns.1967.26.1part2.0159","article-title":"Arterial Compression of the Trigeminal Nerve at the Pons in Patients with Trigeminal Neuralgia","volume":"26","author":"Jannetta","year":"1967","journal-title":"J. Neurosurg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1056\/NEJM199604253341701","article-title":"The long-term outcome of microvascular decompression for trigeminal neuralgia","volume":"334","author":"Barker","year":"1996","journal-title":"N. Engl. J. Med."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Menna, G., Rapisarda, A., Izzo, A., D\u2019Ercole, M., D\u2019Alessandris, Q.G., Olivi, A., and Montano, N. (2022). Surgical and Clinical Outcomes of Microvascular Decompression: A Comparative Study between Young and Elderly Patients. Brain Sci., 12.","DOI":"10.3390\/brainsci12091216"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"185","DOI":"10.3171\/sup.2005.102.s_supplement.0185","article-title":"Gamma Knife Surgery for Trigeminal Neuralgia: Improved Initial Response with Two Isocenters and Increasing Dose","volume":"102","author":"Alpert","year":"2005","journal-title":"J. Neurosurg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1002\/ejp.1779","article-title":"Patient Reported Outcome Measures in Trigeminal Neuralgia\u2014A Systematic Review of Psychometric Performance","volume":"25","author":"Zakrzewska","year":"2021","journal-title":"Eur. J. Pain"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"180","DOI":"10.3171\/2014.8.JNS132547","article-title":"Brief Pain Inventory-Facial Minimum Clinically Important Difference","volume":"122","author":"Sandhu","year":"2015","journal-title":"J. Neurosurg."}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/13\/4\/530\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:01:36Z","timestamp":1760122896000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/13\/4\/530"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,23]]},"references-count":41,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,4]]}},"alternative-id":["brainsci13040530"],"URL":"https:\/\/doi.org\/10.3390\/brainsci13040530","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,23]]}}}