Trigeminal neuralgia (TN) is defined by the International Headache Society as “recurrent unilateral brief electric shock-like pains, abrupt in onset and termination, limited to the distribution of one or more divisions of the trigeminal nerve and triggered by innocuous stimuli.” Treatments for TN are divided into the following three categories: pharmacological treatments; surgical treatments, including microvascular decompression (MVD) and percutaneous procedures, such as radiofrequency rhizotomy (RFR), balloon microcompression, and glycerol injection; and stereotactic radiosurgery. Gamma knife radiosurgery (GKRS) can be used for drug-resistant TN patients who are poor surgical candidates due to medical comorbidities or age or for those who refuse invasive therapy, especially in the absence of other primary indications, such as neurovascular conflict. In this chapter, we aim to explore the history of gamma knife radiosurgery (GKRS) for TN, the rationale of treatment, relevant literature, and the specific methods and outcomes of GKRS.