Background: Primary trigeminal neuralgia (PTN) is known to reoccur following microvascular decompression (MVD) surgery. However, the rates and contributing factors related to PTN recurrence remain controversial. The purpose of this study was to explore the postoperative recurrence rates and related influencing factors of patients with PTN after MVD. Additionally, recurrence rates after different treatments were compared to provide guidelines for clinicians.Methods: We conducted systematic reviews and meta-analyses in accordance with the preferred reporting items of the PRISMA guidelines. We searched nine databases, namely, the PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, CBM, CNKI, VIP, and Wanfang databases, from establishment to July 13, 2020, selecting for studies about the long-term postoperative efficacy of MVD in the treatment of PTN. Factors associated with higher recurrence rates after MVD and long-term postoperative results of other treatments underwent formal meta-analysis, where odds ratios (ORs) with the corresponding 95% confidence intervals (CIs) were calculated. The dose-response model was used to inspect the associations between several factors and higher recurrence rates.Results: Seventy-four studies (8,172 patients, 32 case series studies, and 42 non-randomized controlled trials) were analyzed in our research. Overall, 956 out of 8,172 patients relapsed, and the pooled recurrence rate was 0.096 (0.080–0.113). Influencing factors of relatively higher recurrence rates included atypical trigeminal neuralgia symptoms, lack of nerve groove, non-arterial compression, patients who were 50–60 years old, and longer disease duration. Dose–response analysis showed that the recurrence rate had a significant trend with the published year and the follow-up time. Simultaneously, the recurrence rate of MVD treatment was much lower than that of conventional drug treatment, gamma knife surgery, percutaneous balloon compression, and radiofrequency thermocoagulation. When the surgical technique was improved or combined with partial sensory rhizotomy (PSR), the postoperative recurrence rates were significantly reduced.Conclusions: Even for PTN patients who have a successful operation, ~10% of them will still relapse. This research identifies several factors that can affect the recurrence rate. Compared with other operations, MVD has a relatively lower recurrence rate. Our analysis suggests that improved surgical techniques and combining PSR and MVD will yield better results.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42020159276.

AimThis meta-analysis was performed to evaluate the efficacy and safety of botulinum toxin-A (BTX-A) for the treatment of neuralgia.MethodsWe searched PubMed, EMBASE, and Cochrane databases to identify randomized controlled trials (RCTs) comparing BTX-A treatment with saline for alleviating neuropathic pain. Primary outcome measures were pain scores up to 24 weeks after treatment. Secondary outcomes were hours of sleep, Short Form-36 (SF-36) life quality questionnaire, and adverse events. We used Review Manager 5.3 for the data analyses.ResultsTwelve RCTs were included (n=495). Pain scores in the BTX-A group were significantly lower compared to the saline group at 4 weeks (mean difference [MD] =−1.64, 95% CI [−3.21, −0.07], P=0.04), 12 weeks (MD =−1.49, 95% CI [−2.05, −0.93], P<0.00001), and 24 weeks (MD =−1.61, 95% CI [−2.81, −0.40], P=0.009). There were no significant differences in hours of sleep, SF-36 questionnaire, or the incidence of injection pain or hematoma between the two groups. No serious adverse events associated with BTX-A were noted. Fourteen out of 108 patients (12.9%) with trigeminal neuralgia experienced mild facial asymmetry after the BTX-A treatment.ConclusionBased on the current evidence, BTX-A may be an effective and safe option for the treatment of neuralgia. Due to the limited number of patients included in this meta-analysis, more trials are still needed to confirm these results.

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