Please confirm that an ethics committee approval has been applied for or granted: Not relevant

Background and Aims This study’s objective was to assess the effectiveness and safety of percutaneous balloon compression (PBC) versus other surgical modalities (microvascular decompression [MVD], radiofrequency thermocoagulation [RFT], glycerol rhizolysis [GR], gamma knife radiosurgery [GKRS], for treating primary trigeminal neuralgia (PTN).

Methods A thorough search was conducted throughout the six electronic databases of PubMed, Embase, Web of Science, CNKI, Wanfang Date and VIP, with a timeframe from the creation of the database to August 2023. We selected the clinical studies that included PBC compared with MVD, RFT, GR, or GKRS for the treatment of primary trigeminal nerve and performed Meta-analysis using Review Manager 5.4 and Stata 12.0.

Results It included 29 studies in total. Among the included studies, there was only 1 study in each of the PBC versus GR group and the PBC versus GKRS group, which did not allow for meta-analysis, so these two subgroups were excluded. We found that the pain relief at last follow-up of PBC much more than RFT; the reccurence of pain of PBC much more than MVD. PBC was associated with a significantly higher incidence of facial numbness, a noticeably higher incidence of masticatory muscle weakening and incidence of herpes simplex compared with MVD and RFT, respectively.

Conclusions PBC was superior to RFT for pain relief at last follow-up in primary trigeminal neuralgia. PBC was linked to an increased likelihood of pain recurrence. Following PBC treatment, there was a significant increase in the incidence of three common complications (facial numbness, masticatory muscle weakness, and herpes simplex).