title: Microvascular Decompression Versus Stereotactic Radiosurgery for Trigeminal Neuralgia: A Decision Analysis.
abstract: BACKGROUND
  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.
authors.affiliation: School of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA.
authors.forename: Ian
authors.initials: I
authors.lastname: Berger
authors.affiliation: Neurological Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Nayak
authors.affiliation: Neurological Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA.
authors.forename: James
authors.initials: J
authors.lastname: Schuster
authors.affiliation: Neurological Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA.
authors.forename: John
authors.initials: J
authors.lastname: Lee
authors.affiliation: Neurological Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA.
authors.forename: Sherman
authors.initials: S
authors.lastname: Stein
authors.affiliation: Neurological Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA.
authors.forename: Neil R
authors.initials: NR
authors.lastname: Malhotra
keywords: cyberknife; decision analysis; gamma knife; microvascular decompression; radiosurgery; trigeminal neuralgia