Trigeminal neuralgia is a severe craniofacial pain disorder characterized by recurrent episodes of sudden, intense, electric-shock-like pain in the distribution of the trigeminal nerve. It is most commonly caused by vascular compression of the trigeminal nerve at its root entry zone, leading to focal demyelination and abnormal nerve firing. The condition is highly debilitating and significantly impacts quality of life.

Patients typically describe brief but severe pain triggered by minimal stimuli such as speaking, chewing, or facial touch. Pain episodes may occur in clusters with pain-free intervals but often become more frequent and severe over time. Neurological examination is usually normal, although sensory changes may be present in secondary forms.

Neurosurgical evaluation includes detailed pain history and MRI imaging to identify neurovascular compression or secondary causes such as tumors or multiple sclerosis. Accurate diagnosis is critical, as treatment strategies differ significantly based on etiology.

Medical therapy is first-line treatment; however, a subset of patients develops refractory trigeminal neuralgia due to inadequate pain control or medication intolerance. Surgical intervention is considered in these selected cases.

Microvascular decompression aims to relieve nerve compression while preserving nerve function and offers the highest chance of long-term pain relief. Surgical candidacy is determined by imaging findings, clinical presentation, and patient factors. Alternative procedures may be considered in non-surgical candidates.

Postoperative outcomes are generally favorable, with significant pain relief and preservation of facial sensation. Long-term follow-up ensures early identification of recurrence or complications.

Trigeminal neuralgia surgery requires precise microsurgical technique and careful patient selection to achieve sustained pain relief.