Background: The choice of therapeutic modality for treatment of TGN is guided by etiology, pathophysiology, clinical presentation, age, and co morbidities. The atypical trigeminal neuralgic pain requires treatment of the underlying conditions such as tumors, multiple sclerosis (MS), post-herpetic and post-surgical conditions. Oral pharmacotherapy is usually the first line of management. Peripheral Percutaneous Techniques incorporate the use of chemical (alcohol, phenol, and glycerol) or thermal energy (radiofrequency ablation) to produce a lesion in the branches distal to the Gasserian ganglion. Percutaneous Techniques on Gasserian Ganglion destroy the nerve fibers by employing either radiofrequency, chemicals (glycerol) or mechanical force (percutaneous balloon compression. Posterior Fossa Procedures can be invasive or non-invasive. Recurring episodes of severe lancinating pain in one or more divisions of the trigeminal nerve characterize trigeminal neuralgia (TN), a prevalent pain syndrome. One of the main causes of TN in the cerebellopontine angle cistern is neurovascular compression (NVC) in the root entry zone (REZ) of the trigeminal nerve. When other treatments for TN have failed, the surgeons recommend microvascular decompression (MVD). Even in patients who do not exhibit obvious signs of neurovascular compression, MVD has been demonstrated to alleviate pain. On top of that, MVD is widely believed to deliver the best combination of long-term patient satisfaction and little pain recurrence. Along with our personal experiences, we conducted a comprehensive evaluation of the topic.