Although this is rare, trigeminal neuroglia can be caused by vertebrobasilar dolichoectasia, accounting for just 2% of all patients with trigeminal neuroglia.(1) There are usually multiple offending blood vessels, which vary significantly in number and topology.(1,2) We treated a case using the 3D reconstruction and augmented reality (AR) techniques to assist surgical planning. We found that the patient's vertebrobasilar artery was noticeably elongated (35 mm in length) and dilated (10 mm in diameter), with lateral deviation to the cerebellopontine angle. We further found that the trigeminal nerve was compressed, sandwiched between 3 offending arteries. The patient was treated using microvascular decompression without vertebrobasilar dolichoectasia repositioning, which has become commonplace in the literature.(3-5) The patient consented to the procedure. AR simulation demonstrated that it was challenging for this patient because the large superior petrosal vein obstructed the surgical approach. Postoperatively, the pain completely resolved, and there was no recurrence over a 2-year follow-up period. We found the AR technique to be helpful: It assisted the surgeon in finding all the offending blood vessels and understanding their topology. It also simulated the surgical approach and enabled a tailored surgical plan with a better assessment of the risks involved.