The application of various minimally invasive techniques in neurosurgery has created an era of neurosurgical treatment, in which neurosurgery has made great progress. With the development of the era, the requirements for minimally invasive have become higher and higher, so the concept of precision neurosurgery has been gradually proposed and put into practice, guiding the current direction of neurosurgery development. Primary facial spasm, trigeminal neuralgia and glossopharyngeal neuralgia are a group of related symptoms caused by vascular compression of the corresponding cranial nerve access to the brainstem area. Patients with trigeminal neuralgia and glossopharyngeal neuralgia have severe pain and are generally more willing to operate, whereas patients with facial myospasm are relatively less willing to operate, although they are also more painful. The common feature of this group of diseases is that the disease itself does not directly endanger the patient’s life, so the requirements for treatment effectiveness and safety are much higher. That is, decompression surgery is required to resolve the disease pain while preferably having no or as few complications as possible. Therefore, the objective requirement is that the operator must pinpoint the problem and then perform precise removal of the disease to preserve the patient’s normal function and safety to the maximum extent possible. So how can precision be achieved? The author writes to share with you the experience of applying the concept of precision neurosurgery over the years. In recent years, we have safely carried out microvascular decompression for the treatment of primary facial spasm, trigeminal neuralgia and glossopharyngeal neuralgia in more than 500 cases, with an overall surgical efficiency of 90% and very few surgical complications and no fatal patients, which is summarized below to share with you. As the name implies, precision treatment requires precise and accurate treatment process, not to miss or harass the normal tissue too much, in order to achieve the purpose of minimally invasive. To achieve precise treatment, the operator’s skillful microscopic operation is the basis of treatment, and on top of that, the maximum skillful use of various current technologies is the key. First of all, modern 3.0T high field strength MRI technology such as FIESTA sequence and MRA can already clearly show the number, thickness and course of perineural vessels before surgery. In the past, when these preoperative examinations could not be performed, the operator could only know the relationship between the nerve and the blood vessels when it came to intraoperative, and the surgery would take on an exploratory nature. Nowadays, with preoperative imaging data, it is like having a detailed battle map before the war. Before the surgery is performed, the surgeon can know the general situation of the surgical area, so that he or she can know the enemy and the surgeon can operate with a different degree of precision.