Trigeminal neuralgia (TN) is regarded as one of the most painful conditions afflicting humans. It is a relatively rare disease with an estimated incidence of 4/1 00,000/year. While TN progresses in severity over time, it is not known what proportion of sufferers go on to develop pain refractory to standard medical therapy and then require neurosurgical interventions. A prospective database was established at our center that provides the exclusive neurosurgical services for a relatively constant provincial population of 1.25 million people. Baseline demographics and disease characteristics were recorded for all patients undergoing their first TN surgery between 2001-2010, and any subsequent surgeries for recurrent TN pain up to 2014. Rate of first surgical intervention for TN was calculated as well as rate of failure, defined as patients undergoing subsequent surgery for recurrent TN pain. During the 10 year enrollment period, 163 patients underwent their first surgery with 113 having follow-up of greater than 1 year for TN that had become refractory to standard medical therapy, a rate of 1.4/1 00,000/year. There was significant difference between ages at time of first surgery between MVD and Rhizotomy procedures at 57.2+/-11.9 versus 74.5+/-9.7 years ·of age respectively. MVD expetienced repeat procedures for 13/87 patients while rhizotomy procedures required 29/76 procedures to be repeated. June 18th, 2013 Over one-third of TN sufferers will develop pain refractory to medical therapy requiring surgical treatment. MVD first surgery for TN was associated with the lowest failure rate (14.9%) while 40% of rhizotomy procedures required additional surgery.