<p>Trigeminal neuralgia (TN) is a debilitating facial pain disorder, most often caused by vascular compression of the trigeminal nerve. Microvascular decompression (MVD) is the preferred surgical intervention for drug-resistant cases. However, when the offending vessel is a large, tortuous artery such as the vertebral or basilar artery, conventional decompression techniques using Teflon spacers may be insufficient to achieve effective nerve decompression. This case report describes a patient with left-sided TN who was successfully treated with aneurysm clip-assisted suspension MVD. An aneurysm clip was applied to suspend the vertebral artery, effectively decompressing the trigeminal nerve by separating the two structures. The patient achieved complete symptomatic relief, with no recurrence observed at 2-year follow-up. Aneurysm clips provide robust vessel fixation, minimizing the risk of vessel displacement and recurrent nerve compression. However, precise application is crucial to prevent complications such as vessel kinking. This technique offers a valuable alternative for complex cases where conventional MVD proves inadequate. Further studies are warranted to validate its broader applicability.</p>