Trigeminal neuralgia, also known as painful convulsions, is divided into primary and secondary, and manifests as recurrent episodes of transient paroxysmal severe pain within the trigeminal nerve distribution of the face. The disease is not uncommon, and epidemiological surveys abroad show that the incidence is about 5/100,000 population/year. Due to the huge population base in China, there are a large number of trigeminal neuralgia patients seeking effective ways to relieve their pain every year. Facial pain caused by secondary trigeminal neuralgia with clear etiology, such as tumor, vascular lesion or skull base malformation, which compresses and stimulates the trigeminal nerve, needs to be treated for the primary lesion and is not part of the discussion of this article. This article focuses on the minimally invasive surgical treatment of primary trigeminal neuralgia. There are various speculations on the etiology of primary trigeminal neuralgia, and the most popular theory is that due to demyelinating lesions of some nerve fibers in the sensory afferent pathway of the trigeminal nerve, the afferent nerve impulses are short-circuited, allowing non-injurious sensory impulses to trigger an injurious pain response. In a section of the trigeminal nerve about 1 cm anterior and posterior to the pontine brain, the myelin sheath of afferent nerve fibers changes from a peripheral to a central structure, and the myelin sheath at this site may be more fragile and sensitive to external pressure. There is now abundant evidence that the blood vessels passing through this area, especially the tortuous arteries, can exert pressure on the trigeminal nerve into the pontocerebral region and cause demyelination of nerve fibers, which is the main cause of trigeminal neuralgia. For patients with initial trigeminal neuralgia, medication is still the preferred method and a necessary screening tool, and it is important to take medication while actively performing the necessary tests to exclude secondary trigeminal neuralgia caused by tumors and other etiologies. It is important to note that there is no drug treatment that can cure trigeminal neuralgia, and most patients will experience a gradual decrease in pain control after long-term medication, and sooner or later, intolerable drug toxicities will occur. Since Jannetta advocated trigeminal nerve microvascular decompression in 1967, it has been gradually accepted and widely used by neurosurgeons around the world. 30 years of experience shows that trigeminal nerve microvascular decompression is the only surgical treatment that can cure primary trigeminal neuralgia with high efficiency and low recurrence rate, and can preserve the normal function of the trigeminal nerve. It is the only surgical treatment method that can cure primary trigeminal neuralgia while preserving normal facial sensation, which has relieved the pain and restored normal life for the majority of patients and has been fully affirmed by patients and their families. It is the first choice for the treatment of primary trigeminal neuralgia because it is in line with the development trend of modern neurosurgery of minimizing trauma and preserving function.