Microvascular decompression is the most common operation for trigeminal neuralgia. It aims to stop blood vessels pressing on the root of the trigeminal nerve. Some doctors think this pressure causes most cases of trigeminal neuralgia.
Most people have an MRI scan first to see whether the blood vessels are pressing on the nerve. 
The operation is done in hospital by a brain surgeon (neurosurgeon). You will need a general anaesthetic, and you will have to stay in hospital for several days afterwards. 
The doctor makes a small cut behind your ear and through your skull. He or she uses a microscope and very tiny instruments to move blood vessels away from the nerve root. The doctor then puts some padding around the nerve root to protect it in future. 
If microvascular decompression doesn't work, you can have a second operation. But if you have it again, you are more likely to get problems from the operation. 
There's not much good-quality evidence to show that this operation works to relieve pain in trigeminal neuralgia. A few studies show it works well for many people. But it is a major operation and has some serious risks. 
There aren't any studies looking at how well microvascular decompression works compared with other types of treatment, or compared with not having the operation. But we found one study where 220 people who'd had the operation were asked how satisfied they were with the result.
About 9 in 10 people said they were satisfied, and 8 in 10 said the results were better than they'd expected. 
In another long-term study, more than 1,000 people were followed up for several years after having microvascular decompression. 
Ten years after the operation, 7 in 10 people were free of pain and didn't need medication.
Microvascular decompression is a major operation. Some people get problems (complications) from the operation, although these don't happen very often.
These complications include: 
Up to 1 in 10 people lose the hearing in one ear after microvascular decompression.  
More seriously, some people have strokes or die after the operation.
The study looking at more than 1,000 people found that: 
You may have a type of medicine called a general anaesthetic when you have surgery. It is given to make you unconscious so you don't feel pain when you have surgery.
A magnetic resonance imaging (MRI) machine uses a magnetic field to create detailed pictures of the inside of your body.
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