Aim: To evaluated 20 trigeminal neuralgia patients who were resistant to medical treatments underwent surgery between years 1997-2000 in our clinic. Methods: The surgical procedure was microvascular decompression with lateral suboccipital approach. Surgical results and complications were compared to other techniques with review of the literature. Twenty patients with a mean age of 55 underwent surgery, 12(12%) of them were female and 8(40%) of them were male. Results: Pain was on the left side in 11(55%) and on the right side in 9(45%) patients. Diagnosis of the trigeminal neuralgia was based on the followings: Response to carbamazepine treatment, analysis of the pain with a detailed history, neurological examination and radiological evaluation. 8 patients had a history of hypertension and none of the patients in entire group had a known diagnosis of multiple sclerosis. Pain was experienced mostly on V1,V2 and V2,V3. Cranial magnetic resonance imaging (MRI) was performed to all patients. The etiological factors were estimated as idiopathic or vascular compression in 19, and epidermoid tumor in 1 patient. Patients were operated in semisitting position with a mayfield and lateral suboccipital surgical approach was chosen. Microvascular decompression was applied in 15 patients by using teflon felt and in 4 patients by using goretex. The epidermoid tumor was evacuated in one patient. Superior cerebellar artery was found as the commonest artery that caused entry zone nerve compression. During the postoperative period of 4 months to 3.5 years the 15 (% 75) of the patients were pain-free without any medical treatment; 2(% 10) patients were pain-free on welltolerated medication and mild-pain without medication; 2(% 10) patients had no pain relief; and 1(% 5) patient was pain-free after the operation for more than 1 month followed by the recurrence of pain requiring medical or surgical therapy. Microvascular decompression technique has been suggested superior to alternative methods for its safety and efficacy without recurrence. Conclusion: Our results support the notion that microvascular decompression is the surgical treatment of choice for patients with trigeminal neuralgia who are younger than 70 year-old, have no risk for anesthesia and who are resistant to medical treatments.