Carbamazepine and oxcarbazepine continue to be first choice for Trigeminal neuralgia medical treatment, but have been supplemented by additional options such as pregabalin, lamotrigine, and Onabotulinum toxin A. In patients insufficiently responding to medical treatment, there are neurosurgical treatment options giving very good results. The best long-term results have been described for microvascular decompression, but percutaneous and radiosurgical treatments also are good options, especially in patients with an increased surgical risk profile, in secondary trigeminal neuralgia, and in case of recurrence after microvascular decompression ¹⁾.