BACKGROUND: Whether the total number of compressive vessels in trigeminal neuralgia (TN) affects outcomes after microvascular decompression (MVD) is unknown. OBJECTIVE: To investigate whether the number of compressive vessels is associated with outcomes after MVD. METHODS: We retrospectively reviewed all patients with TN who underwent MVDs at our institution from 2007 to 2020. The number and identity of compressive vessels on the trigeminal nerve were recorded. Preoperative and postoperative pain and numbness Barrow Neurological Institute scores were compared. Factors associated with pain recurrence were assessed using survival analyses and multivariate regressions. RESULTS: We identified 496 patients with a single vessel and 381 patients with multiple vessels compressing the trigeminal nerve. Compared with patients with a single compressive vessel, patients with multiple sources of compression exhibited increased Barrow Neurological Institute pain scores preoperatively (P = .01). In addition, pain recurrence was more frequent (P < .001) and occurred after a significantly shorter pain-free duration (P < .001) for the multiple compression group. Using multivariate ordinal regression, a greater number of arteries (P = .03) and veins (P = .03) were both significantly associated with higher pain scores at final follow-up. Furthermore, the number of arteries (P = .01) and of veins (P = .01) was significantly associated with a higher risk for pain recurrence. CONCLUSION: TN patients with a single compressive vessel exhibited better pain outcomes after an MVD. Patients with multiple compressive vessels exhibited higher pain scores preoperatively and incurred a higher risk for pain recurrence, which occurred after a shorter pain-free interval compared with the single compression cohort.