Trigeminal neuralgia, also known as painful twitching, occurs mostly on one side of the face and presents as a recurrent, transient paroxysmal sharp pain within the trigeminal nerve distribution of the face. Its incidence is 3.4 per 100,000 men and 5.9 per 100,000 women, with the highest incidence during the age of 50-70. Because of the frequent facial pain, it causes great pain to the patient’s body, mind, and daily life and work. Trigeminal neuralgia is generally divided into two types: primary and secondary. Secondary trigeminal neuralgia refers to facial pain caused by compression or stimulation of the trigeminal nerve due to clear causes, such as tumors, vascular lesions and skull base malformations, etc. Treatment is based on removing the primary lesion. This article focuses on primary trigeminal neuralgia. The etiology and pathogenesis of primary trigeminal neuralgia are still unclear, but it is believed that the nerve is “short-circuited” due to the long-term compression of the nerve by blood vessels, resulting in abnormal nerve impulses and nerve pain. The causative vessels are mostly the abnormally shaped vessels of the vertebrobasilar artery system near the root of the trigeminal nerve in the cranium, and the elderly are more prone to trigeminal neuralgia due to atherosclerosis of the cerebral vessels, which makes the vessels longer or twisted. The pain of trigeminal neuralgia is limited to the distribution area of the trigeminal nerve on one side of the face, and the pain is most common in the distribution areas of the II and III branches of the nerve, such as the upper lip, nose, corners of the mouth, incisors and buccal mucosa. The pain attack is often without aura and is sudden and lightning-like, like a cut, burn, pinprick or electric shock, lasting for several seconds or minutes and then stopping abruptly, and the attack is very painful, often accompanied by birth, tears and facial twitching. The painful area often has a trigger point that triggers the pain, and the pain can be triggered by actions such as washing the face, brushing the teeth, talking, or eating. The diagnosis of trigeminal neuralgia is mainly based on the clinical manifestations of the patient, since the physical examination and the CT or MRI scan of the head are not abnormal. Treatment of trigeminal neuralgia is divided into conservative treatment and surgical treatment, the former includes oral medication and drug injection facial nerve block treatment. Carbamazepine is a commonly used pain medication, long-term use or excessive dose may cause dizziness, drowsiness, unstable walking as well as rash, liver damage, bone marrow suppression, etc. Other drugs are: phenytoinamide, heptachyon, baclofen, etc. The main problems of this treatment are the high recurrence rate of pain (23%-54%) and facial numbness, corneal ulceration and chewing difficulties due to nerve damage. Other surgical methods are rarely used due to poor treatment results and high surgical complications. Microvascular decompression was pioneered by an American neurosurgeon in the late 1960s. The procedure is performed under the operating microscope by pushing away the blood vessels located at the root of the trigeminal nerve that are abnormal and cause compression on the trigeminal nerve, and fixing them so that they do not touch the trigeminal nerve, thus relieving the compression of the blood vessels on the root of the trigeminal nerve, restoring the normal function of the trigeminal nerve, and relieving the pain symptoms. The pain symptoms are relieved. With the improvement of this surgical technique, especially its characteristics of minimally invasive, high safety, remarkable effect and low recurrence rate and complications, especially the ability to completely preserve the function of blood vessels and nerves, it was soon accepted by neurosurgeons all over the world and promoted worldwide, becoming the most effective treatment for trigeminal neuralgia. In addition, manifest microvascular decompression has been successfully used to treat facial muscle spasm, glossopharyngeal neuralgia, as well as intractable vertigo, tinnitus, neurogenic hypertension, and spastic diastasis. The procedure is performed under general anesthesia and is painless for the patient. The surgical incision is made in the hairline behind the affected ear, about 3-5 cm long, and a small hole of 1.5 cm in diameter is drilled in the skull. The whole surgical operation is done under a microscope to ensure the delicacy and safety of the operation, which takes about 1 hour.