Many patients with trigeminal neuralgia have been seen over the years. In particular, the proportion of elderly patients who are over 65 years old is not small. People have always been apprehensive when it comes to surgery, especially for elderly patients, who are worried about the dangers of surgery. Therefore, the question of whether to operate in the elderly is more difficult to choose than in younger people. Here, I will talk about my own opinion. 1, Elderly patients with trigeminal neuralgia often have been suffering from the disease for many years and have taken carbamazepine before. However, the effect is getting worse. Even gamma knife or radiofrequency thermal coagulation treatments have been done. But these treatments all have a common problem, that is, they are prone to recurrence. Therefore, often many elderly patients with trigeminal neuralgia have very severe pain, often they are afraid to talk, cannot eat, and cover their faces all day long. 2. On the question of whether to operate or not, children often have very complicated hearts. In the children’s view, the elderly should spend their twilight years in peace after raising them, but being tormented by trigeminal neuralgia is a very sad thing for the children. However, they are worried whether the elderly can withstand the surgery. If there is a problem with the surgery, won’t it be life-threatening? It is understandable that sometimes children do not want their parents to take the risk. 3. How dangerous is the surgery? I think this question needs to be analyzed carefully. The risk for the elderly is mainly from their underlying disease. As with surgery for facial spasm, for example, many people have hypertension, diabetes, coronary artery disease, chronic bronchitis, etc. From our experience of performing surgery on many elderly patients, as long as these diseases are treated carefully before surgery and the body is regulated to an optimal state, the risks are not as difficult as one might think when facing surgery. Therefore, it is most important to work together with the elderly and their children to deal with the preoperative diseases in a thorough manner and help the elderly to have confidence in overcoming the risks of surgery. Thus, the surgery can be completed successfully.