Percutaneous microcompression of the trigeminal ganglion (PMTG) was performed in nine elderly patients ( > 70 years) with trigeminal neuralgia and six patients with atypical neuralgia under short-acting anesthesia using propofol. Two patients had postherpetic neuralgia and two had postoperative neuralgia following removal of a posterior fossa neurinoma. Four patients had recurrent neuralgia following microvascular decompression (MVD). PMTG provided complete relief in 10 patients and the other five patients reported at least 50% improvement. No major complications occurred. PMTG is effective for typical trigeminal neuralgia in elderly patients, patients with atypical trigeminal neuralgia, and patients with recurrence after MVD.