It is common to encounter patients referred from the Department of Neurology with paroxysmal involuntary twitching of the facial muscles on one half of the face, which is clinically diagnosed as paroxysmal facial muscle spasm (commonly known as “facial twitching”), the incidence of this disease is about 11/1 million. The onset of the disease starts from the upper and lower eyelids, and gradually and slowly extends to the cheeks to all the muscles of one side of the face, and in severe cases, it may involve the muscles of the neck. Seizures are obvious during stress and exertion, and there are no positive signs on neurological examination. The disease progresses slowly and generally does not heal itself. 1.Treatment principle At present, the common treatment methods in China are: oral drugs, botulinum toxin injection, radio frequency, surgery and other methods. Undoubtedly, microvascular decompression is the only way to cure facial muscle spasm. Drug treatment is always ineffective. Repeated injections of botulinum toxin injection therapy may be ineffective and can lead to irreversible facial paralysis, myasthenia gravis, and even facial deformity. For patients who can tolerate craniotomy, microvascular decompression is the surgical treatment of choice, superior to other means such as gamma knife or radiofrequency. Indications for surgery ① Excluding secondary lesions; ② Severe symptoms, affecting the patient’s daily life; ③ Patient has the requirement of active surgical treatment; ④ Recommended age is less than 75 years old. 2, postoperative efficacy evaluation criteria: ① cure: the symptoms completely disappeared: ② obvious relief: the symptoms basically disappeared, only in specific circumstances such as emotional tension, the patient is satisfied with the efficacy of treatment; ③ partially relieved: the symptoms are reduced, but still have episodes every day, the patient is dissatisfied with the efficacy of treatment; ④ ineffective: the symptoms do not change or aggravate. Both cases above ① and ② are regarded as effective. About 25% of patients’ symptoms do not disappear immediately after surgery, or reappear after a few days of relief, and it takes a period of time (1 week to 1 year) for the symptoms to gradually disappear, a phenomenon known as delayed cure. In view of this delayed cure phenomenon, it is recommended that postoperative patients be followed up for at least 1 year before evaluating the efficacy of the treatment. It is not advisable to perform a second operation on a patient who still has symptoms in the short term after surgery. The cure rate for microvascular decompression is 95-98%. Surgery can be performed again after failure or recurrence, but the procedure is more difficult, less effective, and has more complications.