Radiofrequency Versus Percutaneous Balloon Compression for Trigeminal Neuralgia: A Systematic Review and Meta-Analysis.

Abstract

Trigeminal neuralgia (TN) is a severe neuropathic pain disorder that may necessitate surgical intervention when medical therapy fails. Among minimally invasive procedures, radiofrequency (RF) lesioning and percutaneous balloon compression (PBC) are most widely used; however, their relative efficacy and safety remain controversial. This systematic review and meta-analysis included only double-arm comparative studies that directly evaluated RF and PBC outcomes in TN. Following PRISMA guidelines, PubMed, Embase, Scopus, and Web of Science were searched to August 2025. Ten double-arm studies comprising 3425 patients (2084 RF, 1341 PBC) were included. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model with Hartung-Knapp adjustment. Primary outcomes included initial and long-term adequate pain relief, recurrence, and permanent complications. Initial adequate pain relief was similar between RF and PBC (RR = 0.999, 95% CI = 0.990-1.008, P = 0.85). Long-term adequate pain relief showed no significant difference (RR = 0.85, 95% CI = 0.68-1.07, P = 0.13). Pain recurrence was comparable (RR = 1.22, 95% CI 0.80-1.87, P = 0.3), as were permanent complications (RR = 1.20, 95% CI 0.56-2.60, P = 0.59). Sensitivity analyses confirmed robust findings, and Egger's tests showed no publication bias. Based on pooled superiority analyses, RF and PBC showed broadly comparable outcomes for several endpoints; however, these findings should not be interpreted as formal equivalence or non-inferiority.