Trigeminal neuralgia is a kind of recurrent paroxysmal severe neuralgia that occurs in the distribution of the trigeminal nerve in the face. The onset of the disease is sudden and abrupt, and the typical manifestation is lightning-like, slashing, burning, intractable and severe pain, which is easily confused with toothache. Facial muscle spasm is a paroxysmal involuntary jerking of the hemifacial muscles, which is more obvious when nervousness and fatigue. The former is mostly caused by vascular compression and accounts for the majority of trigeminal neuralgia and facial muscle spasm; the latter is caused by secondary factors such as local growth tumors. Treatment is recommended if such disorders seriously affect the patient’s life, work, social or psychological well-being. There are many treatment options for trigeminal neuralgia and facial spasm, and surgery is feasible if medications are ineffective. Surgery is performed by cutting the scalp 5-6cm behind the ear, biting off the skull 2×1.5cm in size, focusing on probing the trigeminal and facial nerves throughout the entry and exit of the brainstem and the relationship of the responsible vessels, and then bedding out the responsible vessels with special materials. This type of surgery has exact results, few sequelae and high safety. The key to achieving good results is the surgeon’s experience and judgment; sometimes a very small vein may be the cause of the symptoms.