The initial treatment of trigeminal neuralgia is accomplished with drugs, primarily carbamazepine and occasionally phenytoin sodium. However, many patients become refractory to treatment or side effects develop such as drowsiness or ataxia. In these circumstances, surgical therapy is appropriate. At our institution, microsurgical decompression has yielded good to excellent results in 29 of 32 patients and is currently recommended for persons in good general health who are younger than 70 years. Because of the notable incidence of unpleasant dysesthesias in the face, percutaneous radiofrequency rhizotomy is reserved for persons whose age or general medical condition precludes craniotomy.