Background: The present study was conducted to assess the outcome of patients undergoing microvascular decompression for trigeminal neuralgia. Materials & Methods: The present study was conducted on 54 cases of trigeminal neuralgia (TN) who were treated surgically with microvascular decompression (MVD) over a period of 3 years. In all patients VAS and the Barrow Neurological Institute (BNI) scoring system were recorded. Results: Out of 54 patients, males were 30 and females were 24. Grade I was seen in 35, II in 12, III A in 3, III B in 1, IV in 2 and V in 1 patient. The difference was significant (P< 0.05). Microvascular decompression was performed in superior cerebellar artery in 20 cases and follow up period was 28.4 months, Pon. trigeminal V in 15 cases with 25.2 months follow up, Trans. pon. V in 10 cases with 26.1 months, AICA in 6 cases with 28.2 months follow up and no definite cause in 3 with 27.3 months follow up. Secondary outcome was excellent and good. Conclusion: Authors found that microvascular decompression (MVD) as management for trigeminal neuralgia (TN) have excellent primary and secondary outcome. Key words: Microvascular decompression, Trigeminal neuralgia, Barrow Neurological Institute (BNI) scoring system.