The report details an instance of a 35-year-old male, who came to our hospital with a two-year history of typical trigeminal neuralgia on the left side, predominantly in V2 and V3 dermatomes. The patient was started on medications, but pain could not be controlled by increasing doses and adjuvant medications over the last three months. A lesion was seen on the MRI in the left cerebellopontine angle (CPA) region, hyperintense on T1W and decreased on fat-suppressed imaging, characteristic of lipoma. Being an intractable case, surgery was offered to the patient. Following this, a left retromastoid suboccipital craniectomy was done, and lipoma was excised, decompressing the trigeminal nerve and relieving neuralgia symptoms. In the post-op period, the patient was completely pain-free, but he developed left-sided hearing loss and left facial palsy, Brackmann grade 4, which improved to Brackmann grade 3 on the three-month follow-up.