It is currently believed that the cause of primary trigeminal neuralgia is mainly due to compression of the trigeminal nerve root by abnormal blood vessels. Microvascular decompression is the only treatment for this etiology, and it is also the widely used treatment for trigeminal neuralgia in China and abroad. The procedure involves opening a bone window of about 2cm in diameter behind the ear and releasing the compression of the blood vessels on the trigeminal nerve under the microscope to fundamentally remove the cause of trigeminal neuralgia. With the advancement of microscopic technology, the surgical trauma of this procedure has been greatly reduced compared to the previous one, and it is a standard minimally invasive, locked-hole surgery. With the advancement of technology, more precise determination of the responsible vessels and reduction of complications are the new requirements for this surgery in the post-minimally invasive era. In order to make the surgery more precise and effective, intraoperative electrophysiological monitoring is commonly regarded as an important tool to improve surgical precision in advanced international regions. The intraoperative electrophysiological monitoring system was applied to microvascular decompression surgery in 2012, and after more than one year of application, obvious results have been achieved. The key to microvascular decompression surgery is to accurately determine the responsible vessel and to adequately decompress it intraoperatively. In the past, the judgment of the responsible vessel mainly relied on the operator’s experience, and the decompression effect could be judged only after the patient woke up from anesthesia after surgery, with certain subjective factors. In the case of complex intraoperative responsible vessels, there may be a situation where the responsible vessels are missed. In order to ensure that the pain disappears after surgery, trigeminal sensory root dissection is also performed in some areas. After cutting the sensory roots, complications such as facial numbness and, in severe cases, ipsilateral vision are sure to occur. The intraoperative electrophysiological monitoring system is like a pair of invisible “eyes”, which can help the operator to accurately determine which vessel is the responsible vessel and whether the decompression of the responsible vessel is adequate during the operation and while the patient is under anesthesia. This objective detection index has greatly improved the precision of the operation, making the operation more minimally traumatic and the effect of the operation more guaranteed.