Two personal series of microvascular decompressions due to typical trigeminal neuralgia are presented. Both series have similar size (48 and 54 patients), comparable follow up (38 and 42 month, respectively). The increasing experience of the surgeon did not changed long term succes rate of the procedure (77 and 75 %) but positively influenced complications rate (mainly hearing loss) and more accurate anatomical identification of the offending vessel. The partially known pathophysiology of neuralgia and possible mechanisms of the effect of different treatment modalities are discussed. Microvascular decompression in the treatment of trigeminal neuralgia is an effective and safe procedure which ought be indicated in patients in good medical condition as a method of the first choice.

        Key words: trigeminal neuralgia, microvascular decompression, complications, pathophysiology