Trigeminal neuralgia is still a riddle, especially in the pathophysiology of the tic douloureux, although the problem has been described in many medical publications. The major theory of pain based on the compression of the Vth nerve by tumours or vessels in the rood entry zone (REZ) does not explain the facial pain in patient without neurovascular conflict, with multiple sclerosis or with conflict in places other than REZ. We report a case of the posterior cerebral artery aneurysm, which caused the isolated trigeminal neuralgia in a 48-year-old woman. She was operated on through microvascular decompression and the aneurysm was wrapped. In the second part of this study we review morphological variations of the neurovascular conflict on the basis of anatomical publications. (Folia Morphol 2014; 73, 2: 224–228)
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