I have suffered with TN for many years.
It was almost completely controlled by drugs (a combination of amytripteline, tegretol and gabapentin) but I was very sleepy all the time and my brain was numb. About 18 months ago I had surgery. The one where they put a needle in your cheek and burn the nerve.
It wasn’t painful but the side effects are unpredictable, permanent numbness. Apparently I have the worst case scenario with numb lips and mouth, just like being at the dentist but the pain has gone from excruciating to annoying so I’m happy with the trade off.
I think it depends where you are geographically which surgical solution you are offered. I’m in Leeds where they do thermocoagulation but other areas do different things like gamma knife.
I still take tegretol but after years of use I don’t really feel the side effects.
You really have my sympathy as this is a miserable condition. You need to make your GP your ally in finding the right dosage and drug combination. I used to keep a detailed pain diary so that at each visit I had quantifiable results to the drugs.
I wouldn’t worry too much about Steroids. I think that is a bit of a red herring. I never heard of anyone being prescribed steroids for TN. I used to spend a lot of time on the forums at the TN association – they were very helpful. http://www.tna.org.uk/