Trigeminal neuralgia is divided into two types: primary and secondary, and is characterized by recurrent episodes of transient paroxysmal severe pain within the trigeminal nerve distribution of the face. The disease is not uncommon, and due to the huge population base in China, a large number of trigeminal neuralgia patients are seeking effective ways to relieve their pain every year. Secondary trigeminal neuralgia has a definite cause, such as tumor, vascular lesion or skull base malformation, and requires treatment for the primary lesion. There are various speculations on the etiology of primary trigeminal neuralgia; the most popular theory is that the short-circuiting of afferent nerve impulses due to demyelinating lesions in some nerve fibers in the sensory afferent pathway of the trigeminal nerve allows 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, but no medication can cure trigeminal neuralgia at present. Most patients’ pain control effect will gradually decrease after long-term medication, or they will have to stop medication because they can hardly tolerate the side effects of medication, and choose other treatment options. Microvascular decompression is currently a very important method of treating trigeminal neuralgia, in addition to the Gamma Knife treatment of primary trigeminal neuralgia also has certain advantages. Gamma knife is based on the principle of stereometric orientation, the normal tissue or lesion tissue in the cranium selectively identified as the target, the use of 60Co generated gamma radiation for a one-time high dose of focused irradiation, so that the production of focal necrosis or functional changes to achieve the purpose of treating the disease. To focus gamma rays requires the integrated use of nuclear physics, computers, radiation, electromechanics and a series of modern technologies to achieve. Gamma Knife is a product of modern high technology and is a revolutionary breakthrough in the history of medical treatment. Gamma knife treatment of trigeminal neuralgia has certain advantages. Gamma knife treatment of trigeminal neuralgia is mainly divided into several steps: the patient is scanned meticulously in multiple directions and levels (320-row CT, 3.0T MRI), and a series of images are collected and transmitted to the treatment planning system. The position of the trigeminal nerve is thus clearly displayed and fixed, and its x, y, and z coordinates are determined. The patient’s head localization MRI images are imported into the treatment planning system and the patient’s lesion is displayed. The advanced software system displays the patient’s lesion site in three dimensions and, depending on the patient’s condition, the physician uses an appropriate dose design based on experience. The patient’s head frame is placed inside the helmet according to the treatment planning coordinates and the patient performs the treatment. Throughout the treatment, the Gamma Knife surgeon can keep in touch and communicate with the patient at any time through an intercom phone. Afterwards, the treatment ends, the head frame is removed to go back to the ward to rest, and basically, the patient can be hospitalized and go home the next day without interfering with normal work.