Venous compression is a rare cause of trigeminal neuralgia (TN). Vascular decompression of the trigeminal nerve root, as the only etiopathogenetic treatment of trigeminal neuralgia, is a well-known procedure that is extensively used at various neurosurgical clinics. As the number of interventions for TN increases, the absolute number of surgeries for eliminating venous compression of the trigeminal nerve also grows. Five hundred TN patients underwent surgery at the Neurosurgical Institute in the period from 2000 to 2015. The diagnosis was made based on the criteria of the International Classification of Headache Disorders, the 3rd edition, (ICHD-3) and the Burchiel classification. The study included 211 males and 289 females. The median age was 57 years. All patients had typical TN pain with a unilateral distribution. Two or more branches were affected in 90 patients; one branch was predominantly affected in 10 patients. The median disease duration was 16 months. The median visual analog scale (VAS) score was 8 (very severe persistent pain). In all cases, the patients underwent surgery using the retrosigmoid suboccipital approach. The median postoperative follow-up was 36 months. The aim of this work is to summarize the first experience of the Neurosurgical Institute in surgical treatment for venous compression of the Vth nerve root and suggest methods increasing the efficacy of vascular decompression in patients with this disease.