This work highlights the main variant treatment of patients with trigeminal neuralgia, with a proven neurovascular conflict, microvascular decompression of the trigeminal root. Microvascular decompression is the main radical treatment method which allows to relieve hyperfunctional syndrome manifested by prosopalgia. In the course of this study, the variant anatomy of the neurovascular conflict in patients with trigeminal neuralgia was described in detail. The group of patients whose clinical diagnosis at the stage of selection was based on a neurological examination and taking into account the progression of symptoms as well as the performed instrumental examination (CT angiography). The results are described in the article. Atrophic changes of the root of the trigeminal nerve are visualized and described. The nature of its blood supply is classified according to the type of the origin of the artery or arterial branches of the trigeminal nerve root. The main types of neurovascular conflict classified according to the type of blood vessel are presented. Variant neuroanatomy of the trigeminal nerve root as well as the interaction with the arteries of the vertebrobasilar basin and the veins of the posterior cranial fossa are described. The course of microvascular decompression of the trigeminal nerve root, used in the neurosurgical department of Samara Regional Clinical Hospital n.a. V.D. Seredavin is described

AIM: To determine the group of patients with trigeminal neuralgia for whom the balloon microcompression is the optimal treatment modality. To evaluate the effectiveness of balloon microcompression in the treatment of patients with trigeminal neuralgia. MATERIALS AND METHODS: The study included 52 patients (18 men and 34 women) with trigeminal neuralgia who were operated with the use of balloon microcompression in neurosurgical department of the Samara Regional Clinical Hospital named after V.D. Seredavin over the period from February 2012 to June 2017. The evaluation of effectiveness was carried by Visual Analogue Scale, Macnub scale, the dose tapering of anti-epileptic medicines was also taken into account. RESULTS: In postoperative period the decrease in pain syndrome was noticed by 48 patients (92.3%) from 90 10 to 30 10 points by Visual Analogue Scale. According to Macnub scale 29 patients (55.7%) estimated the level of treatment as good. 19 patients (36.5%) had negative emotional response due to the hypoesthesia, so the result was estimated as satisfactory. 39 patients (75%) managed to decrease the dosage of Finlepsin from 1000-1200 mg to 300-400 mg. Among them there were 8 patients (15%) who subsequently discontinued taking Finlepsin. CONCLUSIONS: Balloon microcompression of Gasserian ganglion is a destructive-symptomatic method that must be considered the main modality only in patients with idiopathic trigeminal neuralgia or with contraindications for operative treatment. Balloon microcompression of Gasserian ganglion is a minimally destructive treatment mode, which allows to increase the effectiveness of treatment due to the alleviation of pain paroxysm in the area of trigeminal innervation and the decrease in dosage of anti-epileptic medicine.