P.151 Repeat surgery for recurrent trigeminal neuralgia: a systematic review and meta-analysis
Bibliographic record
Abstract
Background: The success of repeat surgery for recurrent trigeminal neuralgia (TN)—with microvascular decompression (MVD), percutaneous rhizotomy (PR), or stereotactic radiosurgery (SRS)—is not well-studied. We performed a systematic review and meta-analysis of the literature on repeat surgery recurrent TN, focusing on the durability of pain relief and relative efficacy of MVD, PR, and SRS. Methods: A PRISMA systematic review of Medline/Embase/Pubmed identified studies of adults with unilateral idiopathic TN undergoing repeat surgery. The primary outcome of complete pain relief (CPR) at last follow-up was analyzed with a multivariate mixed-effects meta-analysis of proportions. Results: Seventy-eight studies met criteria; 61 were included in meta-analyses, containing 29/14/25 cohorts with 900/684/1353 patients undergoing MVD/PR/SRS respectively (mean age 64.7 years, 41% males). Initial CPR was 69% (74%/85%/52%). CPR at mean 39.7 month follow-up (38.3/38.8/41.0) was 48% (59%/60%/34%). Initial CPR for both MVD (CPR: 0.78 [0.70-0.85]) and PR (CPR: 0.93 [0.83-0.98]) was superior to SRS (CPR: 0.48 [0.35-0.61]). At follow-up, MVD (0.45 [0.32-0.58]) and PR (0.45 [0.30-0.60]) trended towards superior CPR versus SRS (0.25 [0.15-0.37]). Conclusions: Half of recurrent TN patients achieve good pain control 3 years after repeat surgery. MVD/PR showed superior initial pain relief and likely better long-term relief. These findings can inform surgical decision-making in this challenging population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.027 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.011 | 0.034 |
| Bibliometrics | 0.005 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.009 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".