Microvascular decompression (MVD) is a common surgical technique used for treatment of trigeminal neuralgia (TN) caused by direct vascular compression of the nerve at the brainstem entry zone (BEZ). Here we report a case of a patient (status post-craniotomy for microsurgical clip obliteration of a ruptured mid-basilar artery aneurysm) who developed right-sided TN 6 years after the procedure. During MVD surgery the clip head was found to be compressing the trigeminal nerve at the BEZ, causing Type 1 TN in V3 distribution. This is consistent with the commonly held theory that a pulsatile stimulus is needed to cause TN. To our knowledge there are no previous reports in the literature of an instrument causing TN.