A 62-year-old man presented with medically resistant right trigeminal neuralgia. MRI revealed a vascular loop compressing the cisternal segment of right trigeminal nerve. He underwent microvascular decompression via retrosigmoid approach. During surgery, the trigeminal nerve was seen sandwiched between a vein laterally and superior cerebellar artery loop medially.

Following surgery, the patient recovered well. His neuralgia subsided and he is now off medications.