岩漿海綿腦膜瘤（PCM）由於其深層位置和與重要的神經血管結構的接近而成為治療困難的腫瘤。患有這些腫瘤的患者通常因局部壓迫而出現症狀。一個具有挑戰性的症狀是三叉神經痛（TN），這在大約5%的PCM病例中發生。到目前為止，在治療PCM引起的TN方面，對於微創切除和立體定向放射治療（SRS）何者效果更好尚未達成共識。在這個系統性回顧與荟萃分析中，作者旨在評估有關微創切除與SRS對於控制PCM引起的TN的有效性的相關文獻。從Embase、MEDLINE、Scopus和Cochrane數據庫中，以"(petroclival AND meningioma) AND (trigeminal AND neuralgia)"為搜索詞，檢索自數據庫創建到2022年5月17日的相關文獻。研究納入標準如下：1）報導對於18歲及以上且被診斷為PCM引起的TN的患者，2）治療時進行微創切除或SRS的病例，3）至少有一份治療后的TN疼痛追踪報告的病例，4）至少有一次腫瘤控制結果的病例，5）發表的文章描述隨機對照試驗，比較性或單臂觀察研究，病例報告或病例系列。排除標準包括1）文獻回顧，技術備忘錄，會議摘要或屍檢報告；2）包含的文獻未清楚區分與PCM相關的數據與不同腫瘤或不同部位（其他顱內或脊髓腦膜瘤）的數據；3）包含的文獻中的治療和結果數據不足；4）非英語語言的文獻。篩選符合條件的研究參考文獻以獲取更多相關的研究。比較微創切除和SRS治療組之間的疼痛和腫瘤結果。使用DerSimonian-Laird隨機效應模型和Hartung-Knapp-Sidik-Jonkman變異性修正將納入研究的估計值結合。分析中包括了2個比較性觀察研究和6個單臂觀察研究，共描述了初次介入後的結果（138名患者）。57名患者進行了微創切除，81名患者進行了SRS治療PCM引起的TN。在最後追踪期（平均71個月，範圍24-149個月）中，切除組的疼痛解除率顯著高於SRS組（82%，95% CI 50%－100% vs 31%，95% CI 18%－45%；p = 0.004）。切除後腫瘤復發的中位時間顯著較長（43.75個月vs 16.7個月，p < 0.01）。切除組示出較低的疼痛持續率（0%，95% CI 0%－6% vs 25%，95% CI 13%－39%，p = 0.001）和疼痛惡化率（0% vs 12%，95% CI 3%－23%，p = 0.001）。手術組中最常見的手術後Barrow神經學疼痛評分為I（66.7%），而SRS組為III（27.2%）。在初次切除後很少需要進行手術再介入（1.8%，95% CI 0%－37% vs 19%，95% CI 1%－48%，p < 0.01）。微創切除與SRS相比，在PCM的治療中具有更高的疼痛解除率，更低的疼痛持續率和惡化率。對於不適合進行微創切除手術的患者，SRS及進一步TN管理是一種可行的替代方法。

Petroclival meningiomas (PCMs) are challenging lesions to treat because of their deep location and proximity to critical neurovascular structures. Patients with these lesions commonly present because of local mass effect. A symptom that proves challenging to definitively manage is trigeminal neuralgia (TN), which occurs in approximately 5% of PCM cases. To date, there is no consensus on whether microsurgical resection or stereotactic radiosurgery (SRS) leads to better outcomes in the treatment of TN secondary to PCM. In this systematic review and meta-analysis, the authors aimed to evaluate the available literature on the efficacy of microsurgical resection versus SRS for controlling TN secondary to PCM.The Embase, MEDLINE, Scopus, and Cochrane databases were queried from database inception to May 17, 2022, using the search terms "(petroclival AND meningioma) AND (trigeminal AND neuralgia)." Study inclusion criteria were as follows: 1) reports on patients aged ≥ 18 years and diagnosed with TN secondary to PCM, 2) cases treated with microsurgical resection or SRS, 3) cases with at least one posttreatment follow-up report of TN pain, 4) cases with at least one outcome of tumor control, and 5) publications describing randomized controlled trials, comparative or single-arm observational studies, case reports, or case series. Exclusion criteria were 1) literature reviews, technical notes, conference abstracts, or autopsy reports; 2) publications that did not clearly differentiate data on patients with PCMs from data on patients with different tumors or with meningiomas in different locations (other intracranial or spinal meningiomas); 3) publications that contained insufficient data on treatments and outcomes; and 4) publications not written in the English language. References of eligible studies were screened to retrieve additional relevant studies. Data on pain and tumor outcomes were compared between the microsurgical resection and SRS treatment groups. The DerSimonian-Laird random-effects model with Hartung-Knapp-Sidik-Jonkman variance correction was used to pool estimates from the included studies.Two comparative observational studies and 6 single-arm observational studies describing outcomes after primary intervention were included in the analyses (138 patients). Fifty-seven patients underwent microsurgical resection and 81 underwent SRS for the management of TN secondary to PCM. By the last follow-up (mean 71 months, range 24-149 months), the resection group had significantly higher rates of pain resolution than the SRS group (82%, 95% CI 50%-100% vs 31%, 95% CI 18%-45%, respectively; p = 0.004). There was also a significantly longer median time to tumor recurrence following resection (43.75 vs 16.7 months, p < 0.01). The resection group showed lower rates of pain persistence (0%, 95% CI 0%-6% vs 25%, 95% CI 13%-39%, p = 0.001) and pain exacerbation (0% vs 12%, 95% CI 3%-23%, p = 0.001). The most common postintervention Barrow Neurological Institute pain score in the surgical group was I (66.7%) compared with III (27.2%) in the SRS group. Surgical reintervention was less frequently required following primary resection (1.8%, 95% CI 0%-37% vs 19%, 95% CI 1%-48%, p < 0.01).Microsurgical resection is associated with higher rates of TN pain resolution and lower rates of pain persistence and exacerbation than SRS in the treatment of PCM. SRS with further TN management is a viable alternative in patients who are not good candidates for microsurgical resection.