There are five types of basic treatments for primary trigeminal neuralgia: Chinese medicine; medication; neurosurgical microsurgery; trigeminal nerve peripheral branch closure and destruction; and stereotactic radiation therapy. Chinese medicine treatment mainly includes acupuncture, tonics and Chinese medicine, which can relieve some patients’ pain as an auxiliary treatment. Drug therapy mainly refers to oral carbamazepine treatment, which is both the preferred method for patients with first-onset trigeminal neuralgia and a necessary differential diagnostic tool. However, due to the progressive increase in drug resistance after long-term use, the amount of medication used to control pain also gradually increases, and eventually, patients will be forced to seek other treatments due to intolerable drug toxicities. Neurosurgical microsurgery includes neurovascular decompression and selective trigeminal sensory root dissection and our original selective trigeminal sensory root commissurotomy. Since Jannetta’s invention of trigeminal nerve microvascular decompression in 1967, it has been gradually accepted and widely used by neurosurgeons around the world. Trigeminal nerve vascular decompression is characterized by etiologic eradication while maintaining the integrity of the trigeminal nerve, so it is currently the first advocated treatment for primary trigeminal neuralgia. However, for trigeminal neuralgia of non-vascular compression etiology requires either trigeminal sensory root selective dissection or sensory root selective commissurotomy depending on the intraoperative situation. For patients who can receive trigeminal nerve manifest microvascular decompression, they can receive peripheral nerve disruption, including radiofrequency electrocoagulation selective disruption of the trigeminal semilunar ganglion, glycerol injection disruption of the posterior root of the trigeminal semilunar ganglion, balloon compression of the trigeminal semilunar ganglion, and closure and avulsion of the peripheral branches of the trigeminal nerve. In recent years, the rapidly developing stereotactic radiotherapy (Gamma knife or X-ray knife) technique can achieve pain relief by focusing on the trigeminal nerve roots in the intracranial segment, which is also a kind of peripheral branch destruction treatment. The main problem of this type of treatment is the numbness of the face and mouth after the destruction, which affects the quality of life, and the tendency of recurrence.