Brain stem lesions are known to cause facial pain. Yet, classical trigeminal neuralgia (TN) due to brainstem lesions are very rare. To the best of our knowledge there are 4 cases in the literature with brainstem vascular malformations causing trigeminal neuralgia. We observed two patients with brain stem vascular malformations caused TN. The patient with cavernoma was treated with gamma knife radiosurgery. Second patient with capillary telangiectasia was well responded to medical treatment. We think that the damage to the intra-axial trigeminal nerve pathways resulted with the neuralgia.