A Comprehensive Review of Trigeminal Neuralgia Management :Evidence Synthesis and Future Directions for Acupuncture-Assisted Radiotherapy
Abstract
Purpose
This scoping review aims to synthesize and visually map the extant evidence on trigeminal neuralgia (TN) treatments over the past decade, thereby elucidating the evolving therapeutic landscape. It seeks to identify prevailing research trends and critical evidence gaps, ultimately proposing innovative future directions for both clinical practice and investigation.
Methods
Following the PRISMA-ScR guidelines, we conducted a systematic search of PubMed, Embase, Scopus and Web of Science from November 2015 to October 2025. We included clinical studies on all trigeminal neuralgia treatment modalities. Data from included studies were charted, with therapeutic approaches categorized and analyzed to construct an evidence map and identify research patterns.
Results
Among the 2,847 screened publications, 226 studies were included, comprising 29 randomised controlled trials (12.8%). The analysis indicates a consistent, dominant research focus on surgical interventions, particularly microvascular decompression and percutaneous balloon compression. Pharmacotherapy, predominantly with carbamazepine, demonstrates high short-term efficacy; however, its long-term utility is severely constrained by adverse effects and consequent poor adherence. Stereotactic radiosurgery offers a valuable non-invasive alternative for select patients, though its benefits are characterised by a delayed onset and comparatively higher recurrence rates. Evidence supporting alternative therapies (e.g., acupuncture) is emerging but is currently limited by small-scale studies and significant methodological heterogeneity. Collectively, the mapped evidence highlights a critical, unmet need for refined minimally invasive strategies that optimally balance sustained efficacy with reduced procedural and pharmacological side effects.
Conclusion
Current trigeminal neuralgia management is decisively evolving towards treatment diversification and minimally invasive approaches. Based on the mapped evidence and theoretical mechanistic synergies, we propose a novel interdisciplinary paradigm combining radioneuromodulation with targeted acupoint stimulation. Future research must prioritise rigorous, large-scale clinical trials to validate this and other integrative paradigms. Furthermore, fostering cross-disciplinary collaboration is essential to develop more effective, safer, and genuinely patient-centered therapeutic frameworks for trigeminal neuralgia.