Background; Trigeminal Neuralgia: It is a syndrome characterised by recurrent sudden & usually unilateral severe brief stabbing. One & more branches of 5th cranial nerve are causing pain. It is painful, brief experience. Pain can occur spontaneously & be triggered by innocuous stimuli like yawning, chewing, light touch, & other transmitted stimuli. & divided by different lengths of pain-free intervals, Aim and objectives; to assess effectiveness of Different Modalities in studied cases with trigeminal neuralgia, Subjects & methods; This research Was showed on group of 20 patients having trigeminal neuralgia manged by different modalities, percutaneous radiofrecuency, microvascular decompression, perephiral neurectomy and nerve block. This study was conducted on patients with variant ages at the time of diagnosis, presenting with trigeminal neuralgia, admitted and managed at neurosurgery- Functional unit -Faculty of medicine Al-Azhar University From 2017 To 2021, Result; The description of of radiologiucal findings by MRI FIESTA. The major finding was no loop compassing (50%) in patients followed by Arterial loop compassing trigeminal nerve (35%). Most of the patients had V1, V2, V3 affected in 70% of the patients, and 20% of the patients had V2, V3 affected, The major surgery done was Radiofrequency (40%) followed by MVD (30%).