Background: Trigeminal neuralgia may be “classical” or “symptomatic”. The term classical refers to trigeminal neuralgia (TN) of unknown cause. While the secondary or symptomatic trigeminal neuralgia is due to other causes such as tumors or demyelinating lesions. The pathogenesis of TN and the effect of the different surgical procedures are not completely understood until now. However, the neurovascular conflict theory is a cause widely accepted and can also explain other cranial rhizopathies. Treatment options for the trigeminal neuralgia include medical treatment, ablative procedures (Gasserian ganglion percutaneous techniques, gamma knife surgery) and non-ablative procedure (microvascular decompression). Microvascular decompression is associated with the most favorable outcome.Aim of the study: the study aims to evaluate the effectiveness of microvascular decompression in patients with primary trigeminal neuralgia regarding pain control, recurrence rate, and procedure-related complications.Patients and Methods: We conducted a prospective observational study on 20 patients with primary trigeminal neuralgia, operated upon for microvascular decompression with follow up period at immediate post-operative, 6, 12 months period regarding pain control and recurrence.Results: excellent outcome with complete pain resolution has been observed in 75%, and only 5 % no pain control at immediate post-operative month follow up, there is a 5% incidence of transient facial palsy and CSF leakage.Conclusion: Although MVD surgery is an effective remedy for cranial nerve rhizopathies. Emphasis on operative skills, safety focus, and pre-plans for managing postoperative complications is critical to improving patient outcomes. As these cranial nerve hyperactivity disorders per se are not life-threatening, a safe surgery should be the priority of MVD