In daily life, you often encounter two kinds of patients: an old man playing with his grandchildren in the park, with gray hair and amiable, inadvertently touches the corner of his mouth, and in a moment the pain strikes and keeps slapping his face in pain; a pretty girl at the next table, laughing and chatting, suddenly blinks her eyelids, the corner of her mouth keeps twitching, and her face is full of blush. In 1985, the epidemiological survey on trigeminal neuralgia (TN) in rural areas of 21 provinces and cities in China showed that the incidence of TN was 21.87/100,000 people, and the incidence of facial spasm was 11/1 million in foreign epidemiological surveys, and there are millions of these two types of patients in China, so they are often encountered in daily life. The etiology of trigeminal neuralgia and facial spasm is now basically clear, divided into primary and secondary. Secondary causes are mostly due to localized occupational lesions in the posterior cranial fossa such as cholesteatoma. The primary cause, on the other hand, is the compression of blood vessels. Abnormal excitation of the facial nerve forms nerve impulses, leading to involuntary twitching of facial muscles; while abnormal excitation of the trigeminal nerve leads to discharge-like pain. In trigeminal neuralgia, the site of pain is limited to the distribution area of the trigeminal nerve, and is most common in the middle and lower part of the face, while pain in the middle and upper part of the face alone is less common. A certain area is particularly sensitive and the slightest touch can trigger the pain, called the “trigger point”. The pain is sudden and lightning-like, like a cut, burn, pinprick or electric shock. As the disease progresses, the frequency of attacks increases and the pain level worsens. The disease seriously endangers the health and working life of patients. Facial muscle spasm (unilateral facial muscle twitching) refers to the paroxysmal, involuntary muscle spasm on one side of the face, the twitching mostly starts around the eyes and gradually expands downward, affecting the perioral and facial expression muscles, and in severe cases, it can involve the ipsilateral neck, and the symptoms can be aggravated by emotional tension. Facial muscle spasms affect the patient’s appearance and cause inconvenience to daily life and work. In contrast, bilateral blepharospasm, which is not involved below the eyelids, is mostly seen in children and adolescents and can be controlled by the will, and is not considered facial spasm. In the past, people lacked in-depth and detailed research on the etiology of the above diseases, did not understand their pathogenesis, and tried various treatment methods, such as taking sedatives, antiepileptic drugs such as carbamazepine, phenytoin sodium, vitamins, Chinese medicine, acupuncture, botulinum toxin injection, closure, physical therapy, etc. All these methods failed to target the etiology, so patients failed to see results despite long-term treatment. Even if there is some effect, the patient relapses after a few months. Neurosurgical microvascular decompression for facial spasm and trigeminal neuralgia is an effective and safe procedure, and has become the preferred treatment for this type of disease. In 1966, Jannetta, an American, pioneered the microvascular decompression procedure, which was performed by pushing the responsible vessels away from the trigeminal nerve and facial nerve roots with a cushion. A spacer is placed between the vessel and the nerve, which is like wrapping an insulating tape around a frayed wire, relieving the compression and releasing the bioelectricity build-up, allowing the nerve to return to normal function. The cure rate of facial spasm can reach about 95%, and invalid or recurrent patients can be operated again six months after the first operation and still expect to achieve a cure. Trigeminal nerve root microvascular decompression surgery can preserve the function of the trigeminal nerve, the surgical cure rate of about 85%, such as recurrence of feasible trigeminal nerve posterior root amputation. Anyone without systemic organic pathology such as serious cardiovascular disease and under the age of 75 can be considered for treatment by microvascular decompression. The procedure is performed under general anesthesia with a small incision, a 4-cm incision in the hairline behind the ipsilateral ear, and a local cranial borehole of about 1.5 cm in diameter (minimally invasive lock-hole surgery), where the trigeminal nerve root is explored microscopically, the vessel and nerve root are separated and a special material (Tefflon cotton) is placed between them to isolate the responsible vessel that is compressing the nerve. The treatment is achieved by releasing the nerve compression. The procedure usually takes 1.0-2.0 hours and requires 3 days of bed rest after the procedure, and the incision is discharged after 7 days of stitching. Possible complications include mild facial paralysis, hearing impairment, infection, etc. The chance of occurrence is very low and most of them can be recovered.