In the treatment of recurrent trigeminal neuralgia, what local therapy would you recommend after failure of medical therapy?

I will recommend surgery (microvascular decompression) only when there is a surgically fixable abnormality, such as vascular compression. In that case, microvascular decompression is more effective than SRS. Otherwise, I will offer SRS, which can be offered twice targeting a root entry zone and a more distal segment at recurrence after the first SRS. Having said that, I will always have a functional neurosurgeon evaluate the patient, regardless, and we will discuss the plan after we both see the...