The current state of trigeminal neuralgia treatment in China is rather confusing, with different doctors pushing different treatment methods. Patients are often confused and easily misled. We will give an objective and fair explanation to the majority of patients. 1.What is trigeminal neuralgia? How to confirm the diagnosis? What are the causes of trigeminal neuralgia? Trigeminal neuralgia refers to the pain in the distribution area of the trigeminal nerve limited to one side of the face, with pain in the distribution area of the II and III branches of the nerve, such as pain in the upper lip, nose, corners of the mouth, incisors and mucous membrane of the cheeks, etc. It is most common. The pain is a sudden lightning-like attack, like a knife cut, and the attack is very painful. The painful area often has a trigger point that triggers the pain, and the pain can be triggered by actions such as washing the face, brushing the teeth, talking and eating. Trigeminal neuralgia is known as the first pain in the world, and most of the patients seen in outpatient clinics are afraid to eat, drink and talk, which seriously affects the quality of life! At present, there is no difficulty in confirming the diagnosis because of its obvious clinical manifestations. The etiology is still unclear. The more popular theories are the vascular compression nerve theory, and long-term clinical practice has also confirmed that vascular decompression surgery can relieve pain. Of course, there is also the central pain theory. 2.How to choose the treatment plan for this world’s first pain? At present, there are too many advertisements and too much confusion, and patients are often disorderly and easily misled to spend money. Now we introduce how to treat trigeminal neuralgia in a comprehensive manner. 1) Drug conservative treatment: classic carbamazepine and oxcarbazepine are common drugs for trigeminal neuralgia, and some patients with mild disease can be better controlled. Some patients can be well controlled with gabapentin and other painkillers. The people for whom drug conservative treatment is suitable: patients who are afraid of the risk of surgery and do not want to explain vascular decompression, patients who are afraid of unbearable facial numbness and do not want to receive nerve cutting, blocking or destruction, and patients who are of advanced age and have unstable underlying diseases and have difficulty in tolerating surgery. (2) Microvascular decompression surgery: It was pioneered by an American neurosurgeon in the late 1960s and introduced into China by China-Japan Friendship Hospital in 1984, creating a new way of trigeminal neuralgia treatment. The procedure is to push away the blood vessels located in the root of the trigeminal nerve that are abnormal and cause compression to the trigeminal nerve under the operating microscope, and fix them so that they do not touch the trigeminal nerve, thus relieving the compression of the blood vessels to the root of the trigeminal nerve and relieving the pain symptoms, while completely ensuring the normal function of the nerve, which is the ideal perfect surgery. After nearly 30 years of development and inheritance, the minimally invasive surgery for trigeminal neuralgia has been standardized, matured and perfected day by day. This surgery is especially suitable for young and middle-aged patients who have high requirements for normal nerve function and demanding quality of life. patients over 70 years old who are in good health and have high requirements for quality of life can also use this surgery. (3) Gamma knife treatment: Gamma knife is used to relieve pain by targeting and treating the trigeminal ganglion with targeted radiation. The effectiveness rate is more than 50%, and multiple treatments are possible. Gamma knife has now become an effective method of supplementary treatment for patients who are not suitable for vascular decompression or ineffective after surgery. (4) Nerve blocking type of surgery: percutaneous puncture radiofrequency destruction, percutaneous puncture postganglionic glycerol injection, percutaneous puncture trigeminal nerve balloon compression and percutaneous puncture chronic electrical stimulation treatment, etc. The principle is the same, all are blocking and damaging the trigeminal nerve sensory roots. The main problems with these treatments are the high rate of pain recurrence and the loss of trigeminal nerve function such as facial numbness, corneal ulceration and chewing difficulties that result from trigeminal nerve injury, a necessary sensory loss brought about by pain relief. This type of surgery is relatively less risky and is suitable for patients who do not want or cannot undergo vascular decompression and do not have high quality of life requirements. 5) Trigeminal sensory root dissection: Intracranial dissection of the sensory roots of the trigeminal nerve is performed to achieve pain relief, but it will bring about possible neurological deficits such as facial numbness, ulcers, and difficulty in mastication. At present, this surgical modality is not generally preferred, but can be well combined with vascular decompression surgery, which is suitable for patients who are ineffective after vascular decompression surgery, fear of postoperative pain recurrence, and do not have high requirements for quality of life. 3.Is vascular decompression surgery a one-off procedure? How effective is it? What is the risk of surgery? Vascular decompression surgery can preserve the nerve function intact and relieve pain at the same time, which is the trend of neuroscience development in the world. At present, the efficiency of microvascular decompression surgery for trigeminal neuralgia in the neurosurgery department of China-Japan Friendship Hospital is more than 95% immediately after surgery, and the efficiency is more than 85% at 5 years and more than 80% at 10 years of long-term follow-up. The recurrence rate is about 5%.