What's the best surgery for trigeminal neuralgia?

MVD. Microvascular decompression is an open surgery that involves placing a spongelike material between the trigeminal nerve and a blood vessel pressing on this. This has the best long term outcome. Almost as effective is stereotactic radiosurgery (one well known type is called gamma knife).
MVD. Highest rates of success reported for mvd. This is the only procedure where the goal is to protect the trigeminal nerve. Should be considered for anyone who has continued pain despite best medical therapy, and who is healthy enough to undergo general anesthesia. Older, more frail patients may consider the gamma knife, though response rates are lower, may cause numbness, and take 6 weeks to work.
Consult neurosurgeon. There are couple of options including gamma knife surgery and micro vascular decompression. Consult your neurosurgeon for the best option.