Microvascular decompression surgery has been introduced for 40 years. It has the characteristics of small trauma, good safety, high cure rate and low complication rate, especially it can completely preserve the function of blood vessels and nerves, so it has become the most effective treatment for facial spasm, trigeminal neuralgia and glossopharyngeal neuralgia. MVD is a functional neurosurgery, and although there are risks of anesthesia and craniotomy, unlike cerebrovascular disease or brain tumor surgery, patients and their families have high expectations for the safety and results of the surgery. Therefore, the operator must have some microsurgical experience and ability, understand MVD surgery and have some knowledge of these diseases in order to perform this surgery. Despite the high cure rate and safety of microvascular decompression, there is still a certain rate of complications and mortality. In a survey of 49 hospitals performing microvascular decompression in the United States, Dr. Schmidek et al. found that 14 hospitals had experienced surgical deaths, with a maximum mortality rate of 7%, including those performed by outstanding neurosurgeons. Among the causes of death, intracranial hemorrhage and brainstem infarction were the leading causes. Surgical complications include hearing impairment, facial palsy, facial numbness, hoarseness, dysphagia, diplopia, tinnitus, ataxia, cerebrospinal fluid leakage, intracranial infection, and intracranial hematoma. The incidence of surgical complications is clearly related to the experience and operation of the operator, and intraoperative vascular and nerve injury is the main cause of complications. Therefore, obtaining a 100% cure rate and avoiding complications is the goal of workers in this field. Clinical practice proves that mastering proficient microsurgical skills and local anatomical knowledge, correctly performing local exposure, identification of responsible vessels, selection and placement of cushions, determination of therapeutic effect and prevention of surgical complications in microvascular decompression surgery are the keys to ensure successful surgery.