Trigeminal neuralgia (TN) can be due vertebrobasilar ectasia (VBE), where elongated, tortuous arteries compress the trigeminal nerve, making surgical management challenging. Does a refined microvascular decompression (MVD) technique using a "Teflon cloud" interposition offer sustained symptom relief and medication discontinuation in VBE-induced TN? Three patients with VBE-induced TN were treated between 2017 and 2024. Diagnosis was confirmed by MRI/MRA. MVD with a "Teflon cloud" was performed to cushion the nerve without extensive arterial manipulation. Postoperative outcomes were tracked over an 8-month follow-up. All patients showed immediate, complete relief of TN symptoms, with no recurrences. They discontinued TN-related medications within three months, and no significant complications occurred. These findings suggest that interposition-based MVD using a Teflon cloud effectively addresses TN in the context of VBE by providing stable nerve decompression and minimizing vascular manipulation. A refined MVD with a "Teflon cloud" interposition provides safe, sustained relief for VBE-induced TN, warranting further investigation in larger patient cohorts.