Trigeminal neuralgia is the most common neurological disorder of the brain and is characterized by recurrent episodes of paroxysmal, transient, severe pain within the trigeminal nerve distribution, also known as painful twitching. Trigeminal neuralgia often starts after middle age, is more common in women, and has a unilateral, right-sided onset. Because of its pain like a knife cut, it is jokingly referred to as the “world’s first pain”. Clinically, about 50% of patients have one or more particularly sensitive “trigger points” in the distribution area of the invaded branches of the trigeminal nerve. These “trigger points” vary in size, ranging from a fingernail in diameter to a point or a whisker in diameter. The “trigger points” mostly occur on the upper lip, lower lip, nose, nasolabial folds, gums, cheeks, and corners of the mouth. “Trigger point” sometimes occurs when the face is mechanically stimulated and active, commonly in chewing movements, brushing teeth, washing face, talking, yawning, etc. Sometimes the pain can be triggered by simple sneezing, laughing, tongue movement, turning the head, eating, drinking, or having the face blown by the wind. The pain is sudden and lightning-like, lasting 1-2 minutes to stop, with intermittent attacks that worsen with the duration of the disease. In typical primary trigeminal neuralgia, it is not difficult to make a diagnosis based on the location and nature of the pain attack, the presence of trigger points, the presence of positive signs on neurological examination, and the age of onset. In secondary trigeminal neuralgia, the age of onset is often younger and positive neurological signs are present, so further examination is needed to clarify the diagnosis. Trigeminal neuralgia can be easily confused with toothache, migraine and glossopharyngeal neuralgia, so attention should be paid to differentiation during diagnosis. The treatment principle of primary trigeminal neuralgia is aimed at pain relief, and can be treated symptomatically by various methods such as drugs, closure, radiofrequency, surgery and gamma knife. At present, it is generally believed that trigeminal nerve root microvascular decompression (MVD) is the preferred surgical treatment for primary trigeminal neuralgia. The surgical damage is small, the trigeminal nerve function is preserved, and the recent efficiency is about 95%. A typical case is a 56-year-old woman, Liang, who began to have sudden convulsions on the left side of her face 4 years ago, accompanied by “electric shock-like” severe pain, which was unbearable. After taking oral carbamazepine, the symptoms were slightly relieved. In the past six months, the seizures were frequent, and the pain symptoms could not be controlled after taking more oral medication. After considering the diagnosis of primary trigeminal neuralgia with medical history and magnetic resonance examination results, the patient was recommended to be treated with trigeminal root microvascular decompression, and patiently introduced the typical cases, surgical features, success rate and risks of surgery, hospitalization time, overall cost, etc. The patient and his children initially understood and agreed to the surgery. I was more worried that my surgery would cause medically induced damage to the patient or unsatisfactory results, which also prompted me to complete the preoperative evaluation and intraoperative surgical operation more carefully. After the surgery, the patient woke up quickly and immediately felt no pain in the left corner of her mouth. Looking at the relaxed and comforting smiles of Grandma Liang and her children, my fatigue from the surgery disappeared for a moment. Surgical incision design Surgical reveal Surgical small bone flap