The specific variant of neurovascular conflict is the combination of trigeminal and facial nerves compression in patients suffered from «tic douloureux». This article presents the case report of left-sided progressive drug-resistant trigeminal neuralgia combined with hemifacial spasm. The MR-signs of neurovascular conflict between megadolichobasilar artery and roots of trigeminal and facial nerves were observed during examination of female patient. The microvascular decompression of trigeminal and facial nerves was performed. The close contact between roots of trigeminal and facial nerves and dolichobasilar loop dislocated to the left was revealed during operation. The full regress of symptoms of trigeminal neuralgia and hemifacial spasm was achieved in postoperative period. This clinical case demonstrates the efficacy of microvascular decompression for treatment of complex combined drug-resistant pathology because of one etiologic factor.