Cholesteatoma in the cerebellopontine angle presented as trigeminal neuralgia are not common. Between 2010 and 2013, 12 such patients were operated on in our department. Those patients included 8 females and 4 males with an average age of 47.8 years. One patient was combined with the ipsilateral hemifacial spasm. Five patients had hypesthesia in the ipsilateral side of the face. During the surgery, a pearly sheen mass with boundary was found in the cerebellopontine angle, and the trigeminal root was buried in the tumor. The tumor was removed totally in all the cases. Afterwards, the trigeminal root was observed distorted in 5 and the offending vessel was finally distinguished in 9. Postoperatively, the symptoms were relieved in all the cases and no recurrence was found up to the 36-month period of follow-up. We believed that the etiology of secondary trigeminal neuralgia caused by cholesteatoma is still the neurovascular confliction; the only difference is that the offending vessel was pushed by the tumor instead of idiopathically. Sometimes, the offending artery may not be found after the tumor resection for it may have been transposed off while the tumor is being removed.