The patient, then came 06-January-2007 with agonizing pain, claiming that, she underwent Gamma-knife treatment for neuralgia 24-October-2003 without any benefit.

The patient in mega-doses of neurotop, neurontine, Rivotril, xanax and lexotanil. Despite that, she was in agonizing pain. The patient came urging for surgery.

In setting position, left retromastoid approach was performed and the sigmoid sinus was torn during that, and it was repaired by nylon 6 zero. The vein of Dendy was coagulated and the arachnoid around the left trigeminal nerve was dissected. The arachnoid in the lateral part was thick, which could be due to Gamma-knife effect. The major branch of left AICA was dissected away from under the trunk of the trigeminal nerve. Inspection of the veins was unremarkable. Inspection of one of the branches of the AICA revealed that, it was buried in the brainstem under the axilla of the trigeminal nerve. This part was dissected and the loop was elevated from the inside tissues of the proximal part of the nerve and the loop tip was calcified and turning back to emerge anterior to the trigeminal nerve and then take it's normal course in the brain stem. This loop jumped away anterior to the emergence of the trigeminal nerve. Using muscle coated around the nerve and surgicele between the muscle and the loop and Teflon, separation of the nerve was secured off the loop.

Smooth postoperative recovery and immediate postoperative disappearance of the trigeminal neuralgia. No complications could be noticed.

The golden standard in treatment of neuralgia in young aged patients remain microvascular decompression of the affected trigeminal nerve.

Gamma-knife have suspicious role in trigeminal neuralgia treatment.

Ballooning and radiofrequency thermodistruction have high recurrence rate.