Comparision Of Botulinum Toxin Type A And Icrovascular Decompression In The Treatment Of Diopathic Trigeminal Neuralgia

Objective：To compare the effects of botulinum toxin type A and microvasculardecompression in the treatment of idiopathic trigeminal neuralgia.Methods：Forty-four patients with idiopathic trigeminal neuralgia were involved in thestudy，Twenty-four patients were treated by botulinum toxin type A while twenty patientsreceived the surgery of microvascular decompression. Visual analog scores (VAS) wasused to evaluate the effects of these two treatment by measuring the degree of pain.Results：1、The VAS was9.00±0.88before the BTX-A treatment. The scoresdecreased to5.33±3.38,3.08±2.24，2.00±2.21,3.42±2.76and5.88±2.95at one week,two weeks, one month, three months and six months after the treatment. The effects ofVAS in the treatment of idiopathic trigeminal neuralgia was considered as statisticallysignificant (p<0.001). The VAS was8.95±0.83before the surgery of MVD. The scoreswere2.30±2.23,0.85±1.09，0.30±0.73，0.10±0.45and0.10±0.45at one week, twoweeks, one month, three months and six months after the surgery, respectively. The surgeryof MVD showed significant effects to alleviate the pain from the patients with idiopathictrigeminal neuralgia (p<0.001). The scores of two groups were significant differencesafter the treatments．2、Complications of the treatment with botulinum toxin: three patients had transientnumbness of the mouth askew and incomplete eyelid closure. They got spontaneousrecovery after4to6weeks. Complications of microvascular decompression:3cases ofdizziness, one case of permanent hearing loss; one cases of partial facial numbness;1patient had compression cerebellar hemorrhage of the fourth ventricle due to the cerebellar hemorrhage. The patient received the second surgery for hematoma dissection and gotrecovery with facial numbness. No patients died during the treatment.3、Patients who were subjected to the surgery of microvascular decompression werefollowed up for6months to3years during which3patients had recurrence and therecurrence rate was15.0%. The alleviation of pain by botulinum toxin only persisted for6months after which re-injection of botulinum toxin was required to alleviate pain.Conclusions：1、BTX-A is safe and effective in the treatment of idiopathic trigeminalneuralgia. However, the effects of BTX sustained for shorter time compared with that ofMVD.2、Microvascular decompression (MVD) is more effective in the treatment ofidiopathic trigeminal neuralgia by comparison with Botulinum toxin type A (BTX-A),especially for the relief of pain. However, the MVD has more complications and higherrecurrence rate than BTX-A.3、 For the patients with idiopathic trigeminal neuralgia who are resistant toconventional drug therapy, have surgical contraindications or recurrence after surgery orare afraid of surgery, especially high age, surgical risk big patients,injection of botulinumtoxin type A is an alternative treatment.