[Abstract] Objective To investigate the surgical access for the treatment of trigeminal neuralgia via the horizontal fissure of the cerebellum – pontocerebellar fissure. Methods A retrospective analysis of 50 consecutive cases of trigeminal neuralgia treated by the trans-cerebellar horizontal fissure – pontocerebellar fissure approach was performed, and the efficacy was compared with that of the conventional posterior suboccipital ethmoid sinus approach. Results All patients were able to separate the lateral part of the horizontal cerebellar fissure and the superior limb of the pontocerebellar fissure successfully and all were found to have responsible vascular compression. 50 cases had immediate postoperative pain relief. 3 cases had herpes of the mouth and lips and 2 cases had slight numbness of the affected side. The trigeminal neuralgia treatment via the horizontal fissure of the cerebellum – pontocerebellar fissure of the cerebellum can avoid the defects of poorly revealed trigeminal sensory roots into the pontocerebrum by the traditional posterior suboccipital sigmoid sinus approach, and reduce the occurrence of complications such as hearing loss and facial palsy. There was no case of serious complications in this group.