Background Some studies have indicated that a local injection of Botulinum Toxin Type A (BTX-A) is a promising therapy for trigeminal neuralgia (TN). However, BTX-A treatment is still ineffective for approximately 10–43% of patients. We therefore investigated which factors are associated with the therapeutic effect in BTX-A treatment of medically refractory, classical TN. Methods We performed a retrospective cohort study with a total of 104 patients who were receiving BTX-A injection for medically refractory classical TN between August 2013 and October 2016. A VAS score, pain attack frequency per day as well as patients’ overall response to treatment and side effects were evaluated in 104 patients with TN who were receiving BTX-A. Results A total of 87 patients reported successful results; 41 stated that their pain was completely controlled while 46 reported adequate pain relief, totaling 83.7%. Our study suggests that treatment success was higher in patients 50 or older (OR=3.66, 95% CI: 1.231–10.885). Univariate and multivariate analyses demonstrated that the patient’s age was independently associated with treatment outcome (OR=1.72, 95% CI: 1.063–2.282), with ≥50 years being a significant predictor of pain relief ( P =0.020 and P =0.033, respectively). Seventeen patients (16.3%) reported mild side effects. Conclusion A local injection of BTX-A may be a safe and efficient treatment for classical TN which lasts for several months. BTX-A is a novel strategy which is particularly worth trying for particularly middle-aged and elderly patients who cannot tolerate drug side effects and may be afraid of serious complications from microvascular decompression.

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Trigeminal neuralgia secondary to vertebrobasilar dolichoectasia and basilar artery dissection is rare. The authors report the case of a 72-year-old man with a 5-year history of right electrical facial pain identical with trigeminal neuralgia. Finally, magnetic resonance imaging and digital subtraction angiography revealed basilar artery dissection and vertebrobasilar dolichoectasia. The patient underwent partial basilar dissecting aneurysm embolization. The facial pain was relieved immediately after the operation and disappeared completely 6 months later. Three years after surgery, the patient had experienced no recurrence of the right facial pain.