Facial muscle spasm, also known as facial muscle twitch, is a paroxysmal involuntary muscle spasm on one side of the face, which develops gradually and affects the patient’s appearance, causing great inconvenience to daily life and work. The vast majority of facial muscle spasms are idiopathic (also called primary), and very few are secondary to intracranial tumors, aneurysms, arteriovenous malformations, sarcoidosis, cysts and other lesions. The annual incidence of this disease is 11/1 million in epidemiological surveys. Facial spasm usually does not improve naturally, and the usual conservative treatments such as oral medications, acupuncture, nerve closure, and nerve destruction are mostly ineffective or recur quickly. Many scholars at home and abroad have discovered through decades of research that the intracranial segment of the facial nerve is compressed by blood vessels and the lesion is the root cause of facial muscle spasm. After years of practice and improvement, neurosurgical microvascular decompression for this cause has become the preferred treatment for facial muscle spasm. Patients diagnosed with facial myospasm without systemic organic lesions such as severe cardiovascular disease can be considered for treatment by microvascular decompression. The operation is performed under general anesthesia, and the surgical incision is located in the hairline behind the ear, about 3-4 cm long, after cutting the skin, a window is opened in the local cranium, about 1.5 cm in diameter (minimally invasive locking hole operation). A small piece of cotton ball made of special material (Teflon cotton) is inserted between the vessel and the nerve to pad the vessel away from the facial nerve and to relieve the compression for treatment purposes. The procedure usually takes 1.0-1.5 hours and requires 3 days of bed rest after surgery. The overall efficiency of microvascular decompression for facial myasthenia can reach 95% in experienced neurosurgery centers, with 2-6% of patients being ineffective or recurrent. Postoperatively, patients may have transient headache, dizziness, nausea, vomiting, hypothermia and other reactions, most of which can disappear within a week. There is a possibility of facial palsy and hearing loss after surgery, generally less than 2%, and most of them can gradually recover within 3-months to 6 months once they occur. The incidence of other complications such as intracranial hematoma, cerebellar injury, infection, and cerebrospinal fluid leakage are extremely low. In conclusion, neurosurgical microvascular decompression for facial myasthenia is an effective and safe procedure, and has become the preferred treatment method at present. With the advancement of micro-neurosurgical skills and experience, the surgical efficacy will be further improved and the complication rate will be further reduced, which will relieve the pain of more patients with facial spasm.