Objective To summarize the experience of dealing with the rock vein obstructing the surgical access to trigeminal neuralgia via the horizontal fissure of the cerebellum-bridging cerebellar fissure approach. Methods A retrospective analysis of 55 consecutive cases of trigeminal neuralgia treated via the horizontal cerebellar fissure-bridge cerebellar fissure approach was performed. The rock veins were classified into 3 types according to whether they obstructed the surgical access or not, and were treated separately. Results: (1) The rock vein did not block or basically did not block the surgical access: 17 cases (30.91%); (2) The rock vein branch blocked the access: 30 cases (54.55%), of which 9 cases were cut off; (3) The rock vein trunk blocked the access: 8 cases (14.55%), the trunk was preserved, and the branch was cut off in 2 cases. 52 patients’ pain disappeared completely immediately after surgery, and 3 cases’ pain disappeared completely from the second to the third day after surgery. The pain disappeared completely in 52 patients immediately after surgery, and in 3 cases, the pain disappeared completely in the second to third day after surgery. It is concluded that transcerebellar horizontal fissure – pontocerebellar fissure approach can avoid cutting the trunk of the rock vein or the thick geniculate branch that obstructs the surgical access of trigeminal neuralgia, which can help to reduce the serious complications or even death caused by cutting the trunk of the rock vein or the thick geniculate branch.