Image-guided trigeminal ablation is a safe and effective procedure if medical management of trigeminal neuralgia failed. When compared to conventional two-dimensional (fluoroscopy) or 3D-CT-guided procedures, navigated image-guided interventions require additional procedures including system setup, instrument calibration, registration, verification of accuracy, intraoperative application, and dismantling of the navigation system. Familiarity with these systems is important for their safe and effective use. This technology will enhance patient security and make technical success independent from the interventionalist’s experience with acceptable duration and effort for routine clinical application.