Non-Cochrane · intervention · PM41699350
Keyhole retrosigmoid approach for microvascular decompression surgery: systematic review and single-arm meta-analysis.
Weiger Valentin F, Halbeisen Florian S, Constanzo Felipe, et al. · Neurosurgical review · 2026 · PubMed · doi:10.1007/s10143-026-04178-0
Findings
47 findings
| Population | ||||
|---|---|---|---|---|
| Adults with trigeminal neuralgia, hemifacial spasm or glossopharyngeal neuralgia (all NVCS) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Hemorrhagic or ischemic complication (all transient) Last reported follow-up | Proportion 0.009 GRADE not reported Studies not reported |
| Adults with trigeminal neuralgia, hemifacial spasm or glossopharyngeal neuralgia (all NVCS) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Any surgical complication Last reported follow-up | Proportion 0.139 [0.107, 0.180] GRADE not reported 32 studies · 5767 participants |
| Adults with trigeminal neuralgia, hemifacial spasm or glossopharyngeal neuralgia (all NVCS) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Partial symptom resolution Last reported follow-up | Proportion 0.056 [0.045, 0.069] GRADE not reported 27 studies · 4849 participants |
| Adults with trigeminal neuralgia, hemifacial spasm or glossopharyngeal neuralgia (all NVCS) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Complete symptom resolution Last reported follow-up | Proportion 0.904 [0.877, 0.925] GRADE not reported 31 studies · 5406 participants |
| Adults with trigeminal neuralgia, hemifacial spasm or glossopharyngeal neuralgia (all NVCS) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Permanent neurological deficit (all cranial nerves) Last reported follow-up | Proportion 0.047 [0.030, 0.074] GRADE not reported Studies not reported |
| Adults with trigeminal neuralgia, hemifacial spasm or glossopharyngeal neuralgia (all NVCS) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Infection, wound problem or CSF leak Last reported follow-up | Proportion 0.036 GRADE not reported Studies not reported |
| Adults with trigeminal neuralgia, hemifacial spasm or glossopharyngeal neuralgia (all NVCS) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Transient cranial nerve deficit Last reported follow-up | Proportion 0.054 GRADE not reported Studies not reported |
| Adults with trigeminal neuralgia, hemifacial spasm or glossopharyngeal neuralgia (all NVCS) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Other complications (ataxia, dislodged Teflon pieces, tension pneumocephalus) Last reported follow-up | Proportion 0.011 GRADE not reported Studies not reported |
| Adults with trigeminal neuralgia, hemifacial spasm or glossopharyngeal neuralgia (all NVCS) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Treatment failure Last reported follow-up | Proportion 0.041 [0.028, 0.061] GRADE not reported 26 studies · 4448 participants |
| Adults with trigeminal neuralgia, hemifacial spasm or glossopharyngeal neuralgia (all NVCS) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Symptom recurrence Last reported follow-up | Proportion 0.039 [0.028, 0.054] GRADE not reported 30 studies · 5069 participants |
| Adults with trigeminal neuralgia (TN) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Transient CN V deficit Last reported follow-up | Proportion 0.021 GRADE not reported Studies not reported |
| Adults with trigeminal neuralgia (TN) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Permanent CN VII deficit Last reported follow-up | Proportion 0.006 GRADE not reported Studies not reported |
| Adults with trigeminal neuralgia (TN) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Any surgical complication Last reported follow-up | Proportion 0.115 [0.086, 0.153] GRADE not reported 15 studies · 2112 participants |
| Adults with trigeminal neuralgia (TN) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Permanent CN VIII deficit Last reported follow-up | Proportion 0.019 [0.011, 0.035] GRADE not reported Studies not reported |
| Adults with trigeminal neuralgia (TN) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Treatment failure Last reported follow-up | Proportion 0.037 GRADE not reported Studies not reported |
| Adults with trigeminal neuralgia | Keyhole retrosigmoid microvascular decompression (bone window <=2 cm) | None (single-arm) | Complete symptom resolution Last reported follow-up · Trigeminal neuralgia | Proportion 0.898 [0.855, 0.93] GRADE not reported 14 studies · 1807 participants |
| Adults with trigeminal neuralgia (TN) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Infection, wound problem or CSF leak Last reported follow-up | Proportion 0.036 GRADE not reported 2219 participants |
| Adults with trigeminal neuralgia (TN) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Partial symptom resolution Last reported follow-up | Proportion 0.058 GRADE not reported Studies not reported |
| Adults with trigeminal neuralgia (TN) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Transient cranial nerve deficit Last reported follow-up | Proportion 0.035 GRADE not reported 2219 participants |
| Adults with trigeminal neuralgia (TN) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Permanent cranial nerve deficit Last reported follow-up | Proportion 0.034 GRADE not reported 2219 participants |
| Adults with trigeminal neuralgia (TN) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Transient CN VIII deficit Last reported follow-up | Proportion 0.015 GRADE not reported Studies not reported |
| Adults with trigeminal neuralgia (TN) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Symptom recurrence Last reported follow-up | Proportion 0.043 GRADE not reported Studies not reported |
| Adults with trigeminal neuralgia (TN) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Transient CN VII deficit Last reported follow-up | Proportion 0.011 GRADE not reported Studies not reported |
| Adults with trigeminal neuralgia (TN) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Transient other CN (IX to XII) deficit Last reported follow-up | Proportion 0.007 GRADE not reported Studies not reported |
| Adults with trigeminal neuralgia (TN) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Permanent sensory CN V deficit Last reported follow-up | Proportion 0.026 [0.013, 0.050] GRADE not reported Studies not reported |
| Adults with trigeminal neuralgia (TN) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Hemorrhagic or ischemic complication Last reported follow-up | Proportion 0.009 GRADE not reported 2219 participants |
| Adults with hemifacial spasm (HFS) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Partial symptom resolution Last reported follow-up | Proportion 0.056 GRADE not reported Studies not reported |
| Adults with hemifacial spasm (HFS) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Any surgical complication Last reported follow-up | Proportion 0.167 [0.106, 0.253] GRADE not reported 17 studies · 3616 participants |
| Adults with hemifacial spasm (HFS) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Treatment failure Last reported follow-up | Proportion 0.043 GRADE not reported Studies not reported |
| Adults with hemifacial spasm (HFS) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Permanent cranial nerve deficit Last reported follow-up | Proportion 0.059 GRADE not reported 3625 participants |
| Adults with hemifacial spasm (HFS) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Transient other CN (IX to XII) deficit Last reported follow-up | Proportion 0.009 GRADE not reported Studies not reported |
| Adults with hemifacial spasm (HFS) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Permanent CN VII deficit Last reported follow-up | Proportion 0.021 [0.008, 0.050] GRADE not reported Studies not reported |
| Adults with hemifacial spasm (HFS) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Complete symptom resolution Last reported follow-up | Proportion 0.911 [0.871, 0.940] GRADE not reported 17 studies · 3560 participants |
| Adults with hemifacial spasm (HFS) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Infection, wound problem or CSF leak Last reported follow-up | Proportion 0.032 GRADE not reported 3625 participants |
| Adults with hemifacial spasm (HFS) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Symptom recurrence Last reported follow-up | Proportion 0.031 GRADE not reported Studies not reported |
| Adults with hemifacial spasm (HFS) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Transient CN VIII deficit Last reported follow-up | Proportion 0.020 GRADE not reported Studies not reported |
| Adults with hemifacial spasm (HFS) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Permanent CN V deficit Last reported follow-up | Proportion 0.009 GRADE not reported Studies not reported |
| Adults with hemifacial spasm (HFS) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Permanent CN VIII deficit Last reported follow-up | Proportion 0.050 [0.026, 0.094] GRADE not reported Studies not reported |
| Adults with hemifacial spasm (HFS) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Permanent other CN (IX to XII) deficit Last reported follow-up | Proportion 0.010 GRADE not reported Studies not reported |
| Adults with hemifacial spasm (HFS) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Transient CN VII deficit Last reported follow-up | Proportion 0.042 GRADE not reported Studies not reported |
| Adults with hemifacial spasm (HFS) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Transient cranial nerve deficit Last reported follow-up | Proportion 0.069 GRADE not reported 3625 participants |
| Adults with hemifacial spasm (HFS) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Hemorrhagic or ischemic complication Last reported follow-up | Proportion 0.008 GRADE not reported 3625 participants |
| Adults with glossopharyngeal neuralgia (GPN) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Any surgical complication Last reported follow-up | Proportion 0.188 [0.094, 0.338] GRADE not reported 2 studies · 39 participants |
| Adults with glossopharyngeal neuralgia (GPN) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Symptom recurrence Last reported follow-up | Proportion 0.046 GRADE not reported Studies not reported |
| Adults with glossopharyngeal neuralgia (GPN) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Partial symptom resolution Last reported follow-up | Proportion 0.113 GRADE not reported Studies not reported |
| Adults with glossopharyngeal neuralgia (GPN) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Treatment failure Last reported follow-up | Proportion 0.046 GRADE not reported Studies not reported |
| Adults with glossopharyngeal neuralgia (GPN) | First-time microvascular decompression (with or without internal neurolysis or partial rhizotomy) via a retrosigmoid keyhole approach (bone window <=2 cm) | None (single-arm meta-analysis) | Complete symptom resolution Last reported follow-up | Proportion 0.887 [0.746, 0.954] GRADE not reported 2 studies · 39 participants |
Included primary studies 32
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Artz 2008 Endoscopic vascular decompression. PMID:18698270 | 2008 | this review only | not stated | not extracted yet |
| Blue 2020 Endoscopic Microvascular Decompression for Vagoglossopharyngeal Neuralgia. PMID:33520548 | 2020 | this review only | not stated | not extracted yet |
| Chen 2008 Endoscopic neurovascular perspective in microvascular decompression of trigeminal neuralgia. PMID:18619848 | 2008 | this review only | not stated | not extracted yet |
| Cheng 2008 Endoscopic microvascular decompression of the hemifacial spasm. PMID:19061769 | 2008 | this review only | not stated | not extracted yet |
| Eby 2001 Fully endoscopic vascular decompression of the facial nerve for hemifacial spasm. PMID:17167620 | 2001 | this review only | not stated | not extracted yet |
| El-Garem 2002 Endoscopy as a tool in minimally invasive trigeminal neuralgia surgery. PMID:11875338 | 2002 | this review only | not stated | not extracted yet |
| Ferroli 2010 Advanced age as a contraindication to microvascular decompression for drug-resistant trigeminal neuralgia: evidence of prejudice? PMID:19806315 | 2010 | this review only | not stated | not extracted yet |
| Fu 2024 Application of the semidiving technique in fully endoscopic microvascular decompression. PMID:39174761 | 2024 | this review only | not stated | not extracted yet |
| Guo 2022 Fully Endoscopic Microvascular Decompression for Hemifacial Spasm Using Improved Retrosigmoid Infrafloccular Approach: Clinical Analysis… PMID:35726928 | 2022 | this review only | not stated | not extracted yet |
| Guo 2024 Standard operating procedure and surgical technique innovation in fully endoscopic microvascular decompression for trigeminal neuralgia:… PMID:39186137 | 2024 | this review only | not stated | not extracted yet |
| Huang 2021 The Efficacy and Safety of <2 cm Micro-Keyhole Microvascular Decompression for Hemifacial Spasm. PMID:34395510 | 2021 | this review only | not stated | not extracted yet |
| Iwami 2021 Feasibility of underwater microvascular decompression for hemifacial spasm: a technical note. PMID:34218323 | 2021 | this review only | not stated | not extracted yet |
| Jarrahy 2000 Endoscope-assisted microvascular decompression of the trigeminal nerve. PMID:10964294 | 2000 | this review only | not stated | not extracted yet |
| Li 2018 Retrospective clinical analysis of 320 cases of microvascular decompression for hemifacial spasm. PMID:30313020 | 2018 | this review only | not stated | not extracted yet |
| Liu 2016 Microvascular decompression for atypical hemifacial spasm: lessons learned from a retrospective study of 12 cases. PMID:26339846 | 2016 | this review only | not stated | not extracted yet |
| Ma 2010 Keyhole microsurgery for trigeminal neuralgia, hemifacial spasm and glossopharyngeal neuralgia. PMID:19536556 | 2010 | this review only | not stated | not extracted yet |
| Magnan 1997 Hemifacial spasm: endoscopic vascular decompression. PMID:9339788 | 1997 | this review only | not stated | not extracted yet |
| Montava 2016 Long-term surgical results in microvascular decompression for hemifacial spasm: efficacy, morbidity and quality of life. PMID:27214834 | 2016 | this review only | not stated | not extracted yet |
| Pak 2022 Fully Endoscopic Microvascular Decompression for Trigeminal Neuralgia: Technical Note Describing a Single-Center Experience. PMID:35817347 | 2022 | this review only | not stated | not extracted yet |
| Ricci 2019 Endoscope-assisted retrosigmoid approach in hemifacial spasm: our experience. PMID:29784621 | 2019 | this review only | not stated | not extracted yet |
| Rossini 2024 Microvascular decompression in trigeminal neuralgia using a robot-assisted exoscope and head-mounted display. PMID:39616645 | 2024 | this review only | not stated | not extracted yet |
| Sun 2020 Endoscopic Vascular Decompression for the Treatment of Trigeminal Neuralgia: Clinical Outcomes and Technical Note. PMID:32943913 | 2020 | this review only | not stated | not extracted yet |
| Teo 2006 Endoscope-assisted microvascular decompression for trigeminal neuralgia: technical case report. PMID:17041524 | 2006 | this review only | not stated | not extracted yet |
| Wang 2018 Does Glossopharyngeal Neuralgia Need Rhizotomy in Neurovascular Decompression Surgery? PMID:30320682 | 2018 | this review only | not stated | not extracted yet |
| Wang 2021 Improving recovery after microvascular decompression surgery for hemifacial spasm: experience from 530 cases with enhanced recovery after… PMID:33650924 | 2021 | this review only | not stated | not extracted yet |
| Yan 2021 Facial root entry/exit zone contact in microvascular decompression for hemifacial spasm: a historical control study. PMID:34164468 | 2021 | this review only | not stated | not extracted yet |
| Yang 2014 The efficacy and safety of microvascular decompression for idiopathic trigeminal neuralgia in patients older than 65 years. PMID:24816027 | 2014 | this review only | not stated | not extracted yet |
| Yang 2019 The efficacy and safety of nerve combing for trigeminal neuralgia without neurovascular compression. PMID:30838601 | 2019 | this review only | not stated | not extracted yet |
| Yu 2024 Comparison of the Efficacy of Complete Endoscopic and Microscopic Vascular Decompression in the Treatment of Classical Trigeminal Neuralgia. PMID:39032638 | 2024 | this review only | not stated | not extracted yet |
| Yuan 2005 Microvascular decompression in patients with hemifacial spasm: report of 1200 cases. PMID:15989764 | 2005 | this review only | not stated | not extracted yet |
| Yun 2024 Preliminary Report of Fully Endoscopic Microvascular Decompression. PMID:38583999 | 2024 | this review only | not stated | not extracted yet |
| Zhu 2021 Fully endoscopic versus microscopic vascular decompression for hemifacial spasm: a retrospective cohort study. PMID:33765219 | 2021 | this review only | not stated | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adults (>18 years) with trigeminal neuralgia, hemifacial spasm or glossopharyngeal neuralgia undergoing first-time surgery | 5883 patients: TN 2219, HFS 3625, GPN 39 |
| Intervention | MVD, internal neurolysis or partial rhizotomy via keyhole retrosigmoid approach (bone window <=2 cm) | MVD 5825; internal neurolysis 43; MVD plus partial rhizotomy 15; microscopic 72.5%, endoscopic-assisted 14.6%, fully endoscopic 12.8% |
| Comparison | None (single-arm); comparative cohort studies allowed | None; no study compared keyhole with standard craniotomy |
| Outcomes | Symptom relief (complete, partial, failure, recurrence) and complications (primary); reoperation | Complete resolution 90.4%; partial 5.6%; failure 4.1%; recurrence 3.9%; any complication 13.9%; permanent neurological deficit 4.7% |
| Study designs | Observational studies, case series, comparative cohort studies, technical notes | 32 studies: 23 observational, 9 comparative cohorts; 30 retrospective, 2 prospective |
| Timing | Minimum follow-up 1 month; outcomes at last reported follow-up | Mean follow-up 3.9 years (range 0.1-12.0) |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | No | No | yes |
| 3Choice of study designs explained | No | Yes | no |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | No | No | yes |
| 6Data extraction in duplicate | No | No | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | NRSI: Partial Yes | NRSI: Yes · RCT: N/A | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | NRSI: Yes | NRSI: Yes · RCT: N/A | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Partial Yes | Yes | no |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |