To investigate the characteristics of symptomatic trigeminal neuralgia (TN) caused by tumors and the relationship between anatomicosurgical findings and tumor type, the authors undertook a retrospective review of 35 patients with symptomatic TN between 2006 and 2015. The tumors included 16 meningiomas, 14 epidermoids, 4 vestibular schwannomas, and 1 hemangioblastoma. The studies show that patients with tumor-induced TN were significantly younger than those idiopathic TN (P <0.05). Meningioma-induced TN tended to have responsible vessels, while epidermoid tumor seemed to cause TN by wrapping or compressing the nerve. Additional vascular compression was observed in 15 (42.9%) of these 35 patients. All patients except one showed immediate pain relief following total or subtotal tumor removal with microvascular decompression (if required). Two patients with epidermoid-induced TN experienced symptom relapses caused by tumor regrowth, and one with meningioma-induced TN experienced pain recurrence caused by adhesive arachnoid. The key for operative success is to examine the entire nerve root for possible vascular compression after total or subtotal tumor resection.