Is it safe and effective to choose microvascular decompression for trigeminal neuralgia that failed gamma knife? Of 29 consecutive patients who failed gamma knife treatment, 28 underwent microvascular decompression and 1 refused microvascular decompression surgery. 14 cases saw nerve atrophy, 1 case of arachnoid thickening, and 6 cases of vascular-nerve adhesions. Results: 15 very satisfactory, 1 satisfactory, 2 fair, and 10 unsatisfactory. Complications, 6 cases new or aggravated anterior numbness and 3 cases new or aggravated dysphagia. CONCLUSION: Arachnoid thickening, vascular and nerve adhesions, and nerve atrophy caused by Gamma Knife did not prevent the completion of the procedure. Although the complications of re-microvascular decompression after Gamma Knife are higher than those of the preferred microvascular decompression, microvascular decompression remains safe and appropriate and effective in this patient population.