The application of a dedicated linear accelerator (DLINAC) as a noninvasive surgical treatment for trigeminal neuralgia has not yet been demonstrated. This work evaluates the outcome and indications of 22 patients submitted to DLINAC radiosurgery as a primary treatment for essential trigeminal neuralgia. At last follow-up evaluation, 21 patients (95.5%) had sustained significant pain relief. DLINAC radiosurgery is safe and effective as a primary noninvasive surgical treatment for selected patients with essential trigeminal neuralgia.