What should I do if my trigeminal neuralgia worsens and medication doesn’t work? Trigeminal neuralgia is a disease that has plagued people for many years. In the early treatment, medications are usually used to control the condition. However, the efficacy of medication will diminish over time and gradually become ineffective, so how should trigeminal neuralgia be treated? Trigeminal neuralgia is not only treated with medication. Surgery is the only way to completely resolve trigeminal neuralgia. The procedure is called microvascular decompression. Trigeminal nerve microvascular decompression is the preferred surgical procedure for primary trigeminal neuralgia and is currently the only procedure that can cure trigeminal neuralgia. Under general anesthesia, a 4-6 cm incision is made behind the affected ear along the hairline, the skin and muscles are retracted to reveal the mastoid roots, and a 3 cm diameter bone window is drilled. The dura mater is cut and the cerebrospinal fluid is aspirated under the microscope, the arachnoid is cut and the trigeminal nerve root is explored, and the responsible vessels (one or more) that are compressing the trigeminal nerve root are found. (in case of compression by the rock vein, the rock vein must be dissected). The responsible vessel is freed by microdissection and then padded with a tefflon surface. The procedure is minimally invasive and has a good prognosis. It is the treatment of choice for trigeminal neuralgia.