Muscle Versus Teflon as Interposition Grafts in Microvascular Decompression for Primary Trigeminal Neuralgia: Institutional Series, Systematic Review, and Meta-Analysis

BACKGROUND AND OBJECTIVES: Microvascular decompression (MVD) is considered the gold standard surgical treatment for drug-resistant trigeminal neuralgia (TN), providing sustained pain relief. Te on is the most widely adopted interposing material but may be associated with speci c complications requiring revision surgery. This study aimed to compare clinical outcomes between Te on and autologous muscle grafts as interposing materials in MVD, integrating evidence from an institutional series and current literature. METHODS: A retrospective analysis was performed on an institutional cohort of patients with primary TN who un- derwent MVD using autologous muscle grafts between May 2010 and January 2023. In parallel, a systematic review and meta-analysis were conducted following preferred reporting items for systematic reviews and meta-analyses guidelines, identifying studies that reported recurrence rates and complications after MVD with either Te on or muscle as interposing materials. Only studies with explicit eligibility criteria and extractable outcome data were included for secondary analyses. Kaplan-Meier survival curves analyzed recurrence-free survival and 2-way analysis of variance compared preoperative and postoperative Barrow Neurological Institute score changes where patient-level or retrievable data were available. RESULTS: The analysis included 123 patients from our institutional cohort and 13 288 patients from 69 eligible studies, totaling 13 411 patients who underwent MVD between 1980 and 2023 (38 case series, 7 prospective cohorts, 1 case- control, and 23 retrospective cohorts). Among these, 11 711 received Te on and 1577 received muscle grafts as in- terposing material. Muscle graft was associated with a signi cantly lower risk of pain recurrence compared with Te on (odds ratio = 1.550, 95% CI: 1.209-1.987, P < .01), although recurrence occurred earlier with muscle (mean: 1.55 years) than with Te on (mean: 2.62 years; hazard ratio = 3.786, 95% CI: 2.414-5.937, P < .01). No signi cant difference was observed between groups regarding postoperative pain outcomes (F = 0.22, P = .67). CONCLUSION: Autologous muscle graft is a valid alternative to Te on as an interposing material in MVD for TN, offering similar immediate pain relief and a lower risk of recurrence, despite a shorter time to recurrence.