A patient with trigeminal neuralgia, Zhang, 58 years old, developed right-sided facial pain with no obvious cause 10 years ago, starting with a transient sharp pain in the right cheek near the nose, with repeated attacks of electric shock-like and pinprick-like pain. Later, the episodes became more frequent and the site was variable from above the right corner of the mouth to below the eye fissure. He was diagnosed with trigeminal neuralgia at another local hospital and was given oral carbamazepine treatment. The pain was relieved by taking one tablet orally at the beginning, but after that the attacks were frequent. Despite this, the symptoms were still gradually worsening, and the pain could be induced when Zhang spoke, ate, or brushed his teeth, and the attacks were very frequent and almost uninterrupted, and could not be completely controlled by oral carbamazepine, and could be slightly improved after rest. Li Nan, Department of Functional Neurosurgery, Tangdu Hospital, Fourth Military Medical University The patient tried other methods of treatment, such as acupuncture, local closure therapy, etc., but they could not be completely relieved. In order to seek surgical treatment, Jiang came to our functional neurosurgery department and was admitted to our clinic with “trigeminal neuralgia”. Microvascular decompression was performed under general anesthesia with an 8-cm-long incision in the left posterior mastoid process, and the scalp was cut to the subcutaneous level. The skull surface was exposed by retractor retraction, and 3 holes were drilled in the skull. Bone biting forceps were used to bite open the skull into a 2.5cm*2.5cm size bone flap, and the size of the bone window was about 3.5cm*3. 5cm, and attention was paid to protect the sulcus and sigmoid sinus. The dura was incised with a “ten”, some cerebrospinal fluid was released, the cerebellar hemispheres were retracted posteriorly, the left trigeminal nerve was separated and exposed, and the perivascular compression was seen to be attached to the same vessels, which were carefully separated and padded with small spacers. After strict hemostasis of the operated area and no active bleeding, the dura was sutured and repaired with artificial dura. The connecting piece was returned to fix the bone flap, and the fascia, muscle, subcutaneous and skin were sutured in layers. The surgery was completed successfully. After the surgical treatment, Zhang’s facial trigeminal neuralgia improved significantly, and the pain disappeared completely, with obvious surgical results. The body recovered well. The principle of microvascular decompression for trigeminal neuralgia was introduced The principle of microvascular decompression for trigeminal neuralgia is to observe and find out the responsible blood vessel compressing the facial nerve under the advanced microsurgery technique, then remove that responsible blood vessel and insert a spacer of special material between the responsible blood vessel and the facial nerve, so as to achieve the disappearance of facial pain after the operation. Microvascular decompression for trigeminal neuralgia can not only achieve complete treatment, but at the same time, microvascular decompression is also a minimally invasive surgery, which does not harm any nerve tissue of the face, preserves the nerve integrity and its functionality, and is much safer than acupuncture in Chinese medicine, closed needles in the past, gamma knife and other surgical procedures.