Trigeminal Neuralgia Surgery Options in New York City
If medication isn’t controlling your trigeminal neuralgia (TN), or side effects are getting in the way of daily life, it may be time to talk about procedural treatment. TN is a facial pain disorder known for sudden, severe, electric shock-like attacks that can be triggered by normal activities like talking, chewing, brushing your teeth, or wind on your face.
This page explains the main trigeminal neuralgia surgery options and how surgeons typically match the right procedure to the right patient.
In New York City, Dr. Babu evaluates TN and discusses the full range of options, including procedures aimed at relieving nerve compression and procedures that reduce pain signaling.
When is surgery considered for trigeminal neuralgia?
Surgery or procedures are commonly considered when:
TN is confirmed based on your symptoms and exam
You’ve tried appropriate medications but pain continues, stops responding, or side effects are not tolerable
Imaging supports the diagnosis and helps guide the safest, most effective option
Clinical guidelines note that many patients who need procedural care consider surgery within the first couple of years after symptoms begin, especially if medication isn’t working well.
Step one: confirm the diagnosis and the TN “type”
Not all facial pain is TN, and not all TN behaves the same way. Your treatment plan depends on whether this looks like classical TN (often associated with blood vessel contact/compression of the nerve) or another form where a different underlying cause may be present. High-quality evaluation and good imaging help avoid the wrong procedure.
MRI matters. Many centers use high-resolution trigeminal nerve MRI techniques to look closely at the nerve and nearby blood vessels and to rule out other causes.
The 3 main procedural paths
Most trigeminal neuralgia procedures fall into three categories:
Microvascular Decompression (MVD)
Percutaneous Rhizotomy Procedures (through the cheek)
Stereotactic Radiosurgery (SRS) (focused radiation)
A major theme across major guidelines: patient selection is everything. The right choice depends on your TN pattern, imaging, age/health, and your preferences around invasiveness, numbness risk, and recurrence risk.
Option 1: Microvascular Decompression (MVD)
What it is
Microvascular decompression is surgery designed to relieve pressure on the trigeminal nerve from a nearby blood vessel. The surgeon performs a small opening in the skull (posterior fossa approach), finds the compressing vessel, and moves it away from the nerve, usually placing a soft buffer between them.
Why people choose MVD
It’s designed to treat the cause in classical TN (nerve compression), rather than intentionally injuring the nerve.
Many patients feel relief quickly after surgery, though individual results vary.
Who MVD is best for
MVD is often a strong option when:
Symptoms fit classical TN patterns
Imaging suggests neurovascular compression
You’re a reasonable candidate for surgery and general anesthesia
What recovery can look like (typical)
Recovery varies by person, but MVD is a major operation. Your care team will discuss hospital stay expectations, activity restrictions, and follow-up based on your health and surgical details.
Risks and tradeoffs
Because MVD is intracranial surgery, it has risks that must be weighed carefully. Your surgeon should review risks in plain language, including risks related to anesthesia, bleeding/infection, and neurological complications.
Option 2: Percutaneous Rhizotomy Procedures (minimally invasive, through the cheek)
What this category means
“Percutaneous” procedures reach the trigeminal nerve through a needle pathway, usually through the cheek, to reduce pain signaling. These are often shorter procedures than MVD and may be preferred for people who want a less invasive option or are not ideal candidates for open surgery.
The main types
Guidelines commonly describe these approaches:
Radiofrequency thermocoagulation (radiofrequency lesioning): uses controlled heat to reduce pain fibers
Balloon compression: compresses the trigeminal ganglion briefly
Glycerol rhizolysis (glycerol injection): uses a chemical method to reduce pain signaling
Who these procedures may fit best
Percutaneous procedures can be a good fit when:
You need faster relief and want a less invasive approach
You have health factors that make open surgery higher risk
You accept that numbness can be part of the tradeoff
Common tradeoffs to understand
Facial numbness is more common with neuroablative (nerve-altering) procedures than with MVD.
Recurrence over time can be higher, and some people need repeat treatment. NICE notes recurrence is typically high after percutaneous treatments.
A rare but serious complication across some TN procedures is anesthesia dolorosa (numbness combined with persistent painful dysesthesia). It is uncommon, but important to discuss before choosing a nerve-injuring option.
Option 3: Stereotactic Radiosurgery (SRS, e.g., Gamma Knife)
What it is
Stereotactic radiosurgery uses precisely targeted radiation aimed at a specific portion of the trigeminal nerve to reduce pain signaling. It is not “open surgery” and does not involve an incision.
Why people choose SRS
Non-incisional option
Often considered when someone wants a less invasive approach or has medical conditions that make open surgery less desirable
Tradeoffs and side effects
Numbness/pins and needles can occur, and the NHS notes numbness can be permanent and, in some cases, troublesome.
Pain relief may be less immediate compared with some other procedures (timing varies person to person and by technique), and recurrence is possible.
How Dr. Babu helps you choose the right option in NYC
A good TN surgical consult is not a sales pitch. It’s a matching process.
In a visit with Dr. Babu in New York City, decision-making typically focuses on:
Your symptom pattern (does it match TN criteria and subtype?)
Your MRI findings (is neurovascular compression likely?)
Your medication history (what worked, what didn’t, and side effects)
Your goals and risk tolerance (invasiveness vs numbness risk vs long-term durability)
What to bring
MRI images + radiology report (not just the report if possible)
Medication list (past and current), including side effects
Prior procedure history (dental work, injections, surgeries)
A simple trigger log (what triggers pain, frequency, duration)
Quick comparison: which option fits which situation?
MVD
Best fit: classical TN + likely vascular compression + surgical candidate
Key advantage: addresses compression without intentionally damaging the nerve
Percutaneous rhizotomy
Best fit: needs less invasive option, prefers quick procedure, higher surgical risk, or chooses tradeoff
Key tradeoff: numbness more common; recurrence can be higher
SRS
Best fit: non-incisional preference or not ideal for open surgery
Key tradeoff: numbness can occur and may be permanent; recurrence possible
FAQs
Is microvascular decompression the “best” surgery for trigeminal neuralgia?
For many patients with classical TN and evidence suggesting neurovascular compression, MVD is a leading option because it aims to relieve compression without intentionally damaging the nerve.
But it’s still major surgery, and “best” depends on your health and goals.
Will surgery cure trigeminal neuralgia permanently?
Some people have long-lasting relief, while others may have recurrence and need additional treatment. Guidelines emphasize choosing the right procedure for the right patient and setting realistic expectations.
Do these procedures cause facial numbness?
Numbness is a known tradeoff, especially with rhizotomy procedures and sometimes with radiosurgery. The NHS specifically highlights numbness as a common issue after stereotactic radiosurgery.
What if I’m older or have other medical problems?
That often changes the risk-benefit balance. Less invasive options (percutaneous procedures or radiosurgery) may be discussed more strongly when open surgery risk is higher.
What if I’m not sure I even have trigeminal neuralgia?
That’s common. A careful history plus focused exam and MRI review helps distinguish TN from other facial pain causes and reduces the chance of choosing the wrong procedure