Trigeminal neuralgia (TN) is a neuropathic disorder associated with severe recurrent episodic facial pain affecting predominantly elderly people. Though medical management is effective in pain control in first 2years of symptom onset, many patients eventually require surgical intervention. Preoperative magnetic resonance imaging (MRI) evaluation of posterior fossa helps to identify major etiologies for TN. Neurovascular conflict is a common cause of TN. MRI is unique in imaging entire course of the trigeminal nerve, cisternal segment in particular. Microvascular decompressive (MVD) surgery is a safe and effective method for relieving neuralgic pain in neurovascular conflicts. We described vascular causes of TN, MR sequences useful in imaging of trigeminal nerve, the various vascular etiological possibilities, factors to be mentioned in MRI report.