Between October 1995 and October 1996, we treated 49 patients suffering from trigeminal neuralgia with Gamma Knife radiosurgery. There were 23 males and 26 females. The mean age was 68 (range 38-94 years) The root of the trigeminal nerve close to brain stem was chosen as the target. The maximum dose was 70 Gy in 24 cases and 80 Gy in 25 cases. A single shot with the 4-mm collimator was used. 13 patients underwent Gamma Knife treatment of trigeminal nerve root without any previous surgical procedures. 31 patients suffered from an essential neuralgia (EN), while 7 had neuralgia related to multiple sclerosis (MS). Three had atypical neuralgia (AN) and 8 patients had postherpetic neuralgia (PN). Patients were divided into five groups according to pain reduction. The success rate of pain relief (excellent, very good and good responses) in these patients was: EN 77% of patients, MS 43%, AN 33% and PN 38% of patients. Pain relief occurred after latent intervals of between 1 day and 8 months (median 2 months and mean 2.8 months). Clinically detected complications after radiosurgery occurred only in the form of tactile hypesthesia in 6%. In a selected group of 18 patients, we observed slight electrophysiological changes in 2 patients (11%) after Gamma Knife treatment.