Objective: The aim of this study was to illustrate the clinical characteristics and treatment of trigeminal neuralgia following herpes zoster. Methods: From August 1, 2011 to August 1, 2013, 23 consecutive patients with trigeminal neuralgia following herpes zoster underwent microvascular decompression (MVD) at our cranial nerve disease center. All patients underwent preoperative MRI evaluation, intraoperative observation, and clinical effect evaluation. Clinical data were collected and analyzed in our center. Results: V2 division was the most commonly affected branch. Unlike pretrigeminal neuralgia (PTN), trigger zone was only found in a small part of patients (21.7%). Unlike PTN, the adhesions and compressions between trigeminal nerve and offending vessels were usually not serious; trigeminal nerve usually is atrophic; superior cerebellar artery was the most common offending vessels (65.2%). Of 23 patients, 19 experienced pain relief (82.6%), 1 patient suffered from hearing loss, and another one suffered from cerebrospinal fluid leak; no severe complications were found. During follow-up period, no recurrence was found (3 lost). Conclusions: For patients who suffered from trigeminal neuralgia following herpes zoster, trigger zone was only found in a small part of patients. The trigeminal nerve usually is atrophic; microvascular decompression was equally applied to these patients if vessel compression was confirmed.