[Overview] The origin of microvascular decompression MVD began with clinical studies on the surgical treatment of trigeminal neuralgia (TN). Decades of research have shown that compression of the cerebelloponline angle (CPA) by vessels responsible for nerve roots entering/exiting the brainstem can lead to a syndrome known as neurovascular compression (NVC). MVD has become the surgical treatment of choice for patients with primary TN, glossopharyngeal neuralgia (GN) who can tolerate craniotomy. The combination of MVD with CPA partial rhiZotomy (PR) to maximize surgical efficiency and minimize complications is a major effort of functional neurosurgeons. History taking】 The distribution area of trigeminal nerve or glossopharyngeal nerve, the location, nature, onset and relief of pain, and concomitant conditions. Physical examination】 Generally, there are no obvious positive signs. Auxiliary examination】 1. Laboratory examination: blood routine, blood biochemistry, coagulation routine, blood type and complete set of examination before blood transfusion (12). 2. Imaging examination: cranial MRTA examination to investigate the relationship between intracranial blood vessels and trigeminal nerve and linguopharyngeal nerve. Clinical manifestations of primary GN: GN is rare, with episodes of pain limited to the root of the tongue, tonsil area, pharynx, mandibular angle, mastoid area, and external auditory canal area, which can be triggered by swallowing, chewing, talking, coughing, and yawning. Carbamazepine is mostly effective. 2. Clinical manifestations of primary TN: Primary TN is mainly manifested by recurrent paroxysmal severe pain in the trigeminal nerve distribution area. Most of the pain is unilateral, and occasionally bilateral onset is seen as tearing, electric shock, stabbing, cutting or burning pain, which may be accompanied by lacrimation, salivation, runny eyes or facial convulsions. Trigger points or trigger points exist, mostly located in the upper and lower lips, nose, nasolabial folds, gums, cheeks, and corners of the mouth, and can be triggered by actions such as chewing, eating, drinking, wind, cold, brushing teeth, washing face, and speaking. Some patients may have intermittent periods ranging from several weeks to several years. Differential diagnosis】 1. The differential diagnosis of primary GN: the stem is too long, CPA occupying lesion, malignant tumor (such as nasopharyngeal carcinoma) invading the skull base is its common secondary cause, so the frontal and lateral flat film of the stem and CT or MRI should be routinely examined before surgery. 2. Primary TN should be differentiated from other painful diseases of the head and face. For example, GN, intermediate neuralgia, pterygopalatine neuralgia, atypical facial pain, cluster headache, postherpetic pain, odontogenic pain, etc. Typical primary TN clinical features that can be differentiated include: (1) clear range of pain; (2) episodic; (3) presence of remission period; (4) presence of triggering factors and trigger points; (5) initially effective with carbamazepine. (1) Oral carbamazepine and dobutamine treatment. (2) Radiofrequency ablation therapy. 2. Surgical treatment: (1) Indications for surgical resection: Indications for surgery for TN and GN include: (1) primary TN and GN, excluding secondary lesions; (2) severe symptoms that affect the patient’s daily life; (3) poor conservative treatment or serious side effects; (4) the patient has the requirement for active surgical treatment. (2) Contraindications to surgery: Contraindications to surgery: (1) Same as other contraindications to craniotomy with general anesthesia, such as the presence of serious systemic diseases with poor control; (2) Insufficient understanding and preparation of the patient for the efficacy of surgery and the possible complications. (3) Surgical approach; posterior sigmoid sinus approach with microvascular decompression. (1) Cure: complete disappearance of symptoms; (2) Significant remission: basic disappearance of symptoms, occasional attacks but no drug treatment; (3) Partial remission: symptom reduction, but still need drug control; (4) Ineffective: no change or worsening of symptoms. Both of the above (1) and (2) are considered effective. 2. Criteria for evaluation of postoperative efficacy of GN: (1) Good efficacy: complete disappearance of pain or greater than 95% relief without medication; (2) Average efficacy: greater than 50% pain relief with or without medication; (3) Poor efficacy: no pain relief.