Although the efficacy of microvascular decompression surgery for facial myasthenia is certain, the cure rate is still not guaranteed to reach 100%. Among the factors affecting the cure rate, the experience of the surgeon and the operating skill of handling the responsible vessels are particularly important for the postoperative outcome. The suspension method is a useful supplement and improvement to the traditional microvascular decompression, and it is a surgical method that deserves further improvement and promotion. Of course, the surgeon must be skilled in microsurgery, and a clear understanding of the microscopic anatomy of CPA and the correct judgment of the responsible vessel are the most important prerequisites and guarantees to improve the surgical efficacy and reduce complications. The suspension method allows for the separation of difficult venous compressions and vertebral artery compressions to leave the REZ of the facial nerve. I personally believe that the following matters should be noted during surgery: ① The patient’s head must be positioned correctly during surgery, otherwise it will affect the exposure and operation of the facial nerve REZ during surgery. The correct head position should be 15° down and 10° rotated to the healthy side, with the neck slightly flexed forward and the highest position of the affected mastoid should be the highest position of the head on the surgical bed. ② The bone hole should be close to the posterior border of the sigmoid sinus anteriorly and close to the skull base downward, and the bone hole should not be too small to affect the surgical operation. ③ Do not use a bony head frame to fix the head during surgery, because the anterior-posterior rotation of the head can be used to keep the optical axis of the operating microscope in line with the approach during surgery, which can not only ensure good exposure of the facial nerve REZ, but also reduce the complications caused by excessive pulling of the cerebellar hemispheres. The posterior cranial nerve roots and the arachnoid membrane covering the facial nerve REZ and the local vessels are opened in a sharp detachment, which can clearly reveal the facial nerve REZ; before dissecting the arachnoid membrane, the surgeon should pay attention to the direction of the local vessels to prevent the vessels from shifting after extensive dissection of the arachnoid membrane, thus affecting the surgeon’s judgment of the responsible vessels. ⑤ The responsible vessel usually passes through the facial nerve REZ in a collaterals and causes compression; however, the vessels located in contact with or parallel to the facial nerve trunk are not the responsible vessels. When multiple vessels are present in the facial nerve root REZ, the responsible vessel compressing the facial nerve root is often located on the deep side of the multiple vessels. The responsible vessel should be sharply free of the responsible vessel, and then a pad should be inserted between the vessel and the nerve, and the pad should be lifted and wrapped around the vessel toward the skull base to push the responsible vessel away from the facial nerve REZ. to prevent repositioning of the vessel, the pad should be of appropriate size and placed between the responsible vessel and the brainstem. (7) The decompression material should be torn into small balls of cotton to make it soft and flexible, and then made into a cigar shape for easy fixation. Note that the thickness and size of the decompression pad should be appropriate, and avoid contact between the pad and the facial nerve REZ. When the responsible vessel is a thick, tortuous, sclerotic vertebral artery that is difficult to push or when there are multiple short penetrating arteries or when the penetrating artery is located exactly between the facial and auditory nerve roots, the operation is often difficult, and the skillful microsurgical technique of the surgeon is very important for adequate decompression and avoiding complications. The nerve endoscope can make up for the deficiency of the control field of the operating microscope, and it can be used to observe the angle that cannot be reached by the microscope during the microvascular decompression surgery, so that a comprehensive view of the facial nerve REZ can be obtained without excessive stretching of the cerebellum and nerves, and the direction of the responsible vessels can be determined, and the decompression pad cotton can be placed correctly.