While most of the studies examining radiosurgery for trigeminal neuralgia have used a Gamma Knife, a linear accelerator can also be utilized for treatment. We report on 20 patients with trigeminal neuralgia who received 23 treatments with a linear accelerator that delivered a maximum dose of 82.3–100 Gy. The median patient follow-up was 56.5 months, 70% of patients had received previous surgical treatment and 20% had secondary (nonessential) trigeminal neuralgia. Eight (35%) radiosurgery treatments resulted in complete pain relief; 5 (63%) patients with initial pain relief had pain recurrence at a mean time of 21.5 months. Ten (43%) patients reported a 50% or more decrease in pain severity but have not achieved a pain-free state. A total of 18 (78%) treatments resulted in no pain or a 50% or greater improvement in pain. Five treatments (22%) resulted in less than 50% improvement in pain. We conclude that linear accelerator stereotactic radiosurgery is a viable treatment option for trigeminal neuralgia patients, especially for patients who have not had a previous invasive treatment.

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