Stereotactic Radiosurgery for Trigeminal Neuralgia Secondary to Vertebrobasilar Dolichoectasia: A Systematic Review and Meta-Analysis Publisher



Hajikarimloo B ; Tos SM ; Mohammadzadeh I ; Kim YH ; Habibi MA ; Shinya Y
Source: Clinical Neurology and Neurosurgery Published:2026

Abstract

Background Trigeminal neuralgia (TN) secondary to vertebrobasilar dolichoectasia (VBD) is a rare and surgically challenging condition due to the complex anatomy and elevated risks of open craniotomies. Stereotactic radiosurgery (SRS) offers a minimally invasive alternative, but evidence has been limited to small case series with variable outcomes. To address this gap, we conducted the first meta-analysis to evaluate the efficacy and safety of SRS for VBD-related TN. Methods Following PRISMA guidelines, PubMed, Embase, Scopus, and Web of Science were searched from inception to August 2025. Statistical analyses were performed in R. Sensitivity analyses, publication bias assessment, and meta-regression were conducted. Results Five studies involving 90 patients were included. The pooled initial complete pain relief rate was 68% (95% confidence interval [CI]: 6%–100%), and initial adequate pain relief was 95% (95% CI: 77%–100%). At the final follow-up, complete pain relief was reported in 28% (95% CI: 0%–72%) of cases, and adequate relief was reported in 81% (95% CI: 43%–100%) of cases. Pain recurrence occurred in 44% (95% CI: 7%–85%), while 39% (95% CI: 0%–91%) required salvage interventions. Transient facial sensory disturbance was 19% (95% CI: 0%–97%), and permanent facial sensory disturbance was negligible at 0% (95% CI: 0%–4%). Meta-regression identified vascular anatomy, trigeminal division involvement, and sex distribution as significant predictors of outcome. Conclusions SRS provides meaningful pain relief with minimal permanent toxicity in VBD-related TN. Nonetheless, recurrence and salvage needs remain substantial, underscoring the importance of prospective studies to refine patient selection and treatment strategies. © 2026 Elsevier B.V.