In a retrospective study of 206 patients diagnosed with trigeminal neuralgia (TN), we examined the results of percutaneous balloon compression (PBC) of the Gasserian ganglion performed by the same surgeon from September 1991 to November 2005. In these patients, 230 procedures were done. All patients had clinical follow-up for a minimum of 3 years while being evaluated for any recurrence of the symptoms. Initial pain relief was complete in 214 operated patients (93%) while in 16 operated patients (7%) it was not. From those, nine patients had another PBC performed immediately with eight of them becoming pain free while the remaining seven patients opted for medical treatment. From that last group, we found that six patients ended up experiencing resolution of their symptoms. In total, only 2 patients (1%) from the original 206 did not improve initially, while 99% had an excellent response. After a 3-year follow-up, only 35 patients (15%) had developed recurrent symptoms. In the majority of cases, the recurrence occurred between 2 and 3 year intervals (16 patients). There was no mortality. The low cost, low morbidity, low recurrence rate and high positive results make this procedure a valid option in the treatment of trigeminal neuralgia refractory to medical treatment.