The incidence of trigeminal neuralgia is about 5/10. Generally elderly people are affected by the so called "essential" form, although an early onset is not infrequent in secondary forms. The etiopathogenesis as well as the efficacy of different surgical treatments are still unclear because of the lack of animal sperimental models and of randomized controlled clinical studies. Nevertheless the hypothesis of a vascular conflict as the main etiologic factor is generally accepted. According both to our experience and to the literature data, microvascular decompression in the cerebello-pontine-angle appears to be the best clinical option presenting the most advantageous cost-benefit balance. The use of percutaneous lesive techniques, even if effective, should be limited in consideration of the risk of developing neuropathic disturbances, sometimes more difficult to treat than the original pain.