Trigeminal neuralgia is a painful disorder of the face that negatively affects the functionality of those who suffer from it. Microvascular decompression remains the top choice for its short and long-term outcomes. In those who are not candidates for open surgery, ablative options become valuable, including radiosurgery, and radiofrequency, balloon, and glycerol rhizotomies. Radiosurgery can be useful in cases of trigeminal neuralgia associated with multiple sclerosis. A scheme is proposed to facilitate decision-making considering outcomes, predictors of response and complication rates.