Trigeminal neuralgia (TN): is a neurological disorder that occurs in the face with severe pain, such as discharge, knife-like pain symptoms, and unbearable for normal people. The incidence of TN is high, the age is more after 40 years old, and there are more women than men. The incidence rate is 47.8/100,000 and 62.6/100,000 respectively, with more women than men, and the incidence rate can increase with age. Etiology: Trigeminal nerve (Vth cranial nerve): it is a mixed cranial nerve, which is responsible for most of the tactile sensation, temperature sensation and pain in the head and face above the jaw, as well as the masticatory muscle. There are several theories about trigeminal neuralgia, but the dominant theory now is that direct compression or beating impact of normal vessels (often the superior cerebellar artery, SCA) on the segment of the nerve exiting the brainstem causes degeneration of the nerve myelin sheath and triggers abnormal electrical activity, which leads to severe pain induced by any slight stimulation in the innervated area, and that pain does not end immediately when the stimulus disappears. Rare causes are: aneurysms, vascular malformations, tumors, arachnoid cysts in the CPA area, and craniocerebral injuries. Prolonged compression causes demyelinating changes followed by axonal degeneration, so it is mostly agreed that trigeminal neuralgia is associated with axonal degeneration. Several studies have found that trigeminal neuralgia occurs in about 3-4% of patients with multiple sclerosis (MS) and has a younger age of onset, which is theorized to be caused by destruction of the spinal tract of the trigeminal nerve. Herpes zoster virus is associated with trigeminal neuralgia, and a case was encountered in an outpatient clinic: the patient presented with “multiple herpes on the right frontal zygomatic area” and was asked about the history of trigeminal neuralgia more than 10 years ago. Diagnosis: Due to the lack of characteristic physical examination and laboratory tests, trigeminal neuralgia is often incorrectly diagnosed, so patients often wander to related departments, such as dentistry, pain department, neurology, etc., before being diagnosed. The theory is that the longer the duration of the disease, the more difficult it is to reverse the pain-related conduction pathways. The diagnosis of trigeminal neuralgia is first considered based on the patient’s description of the pain, (1) type of pain: sudden and abrupt, electric shock-like, lasting from a few seconds to about 2 minutes; (2) location of pain: the range of pain in the face, which helps to understand which nerve branches are affected; (3) “trigger point”: mostly triggered by light activity and touching triggered by light activities and touch, such as eating, talking, or even blowing a cool breeze. After trigeminal neuralgia is identified, the etiology needs to be further defined. Tests include neurological physical examination, cranial MRI to rule out multiple sclerosis (MS), tumors, and other factors, and sometimes intravenous medications are needed to clarify the vascular pattern of the associated arteries, and MRA is also helpful to clarify the vascular condition. Differential diagnosis: includes temporomandibular joint dysfunction because it can be induced by facial muscle and tongue movements and the pain is somatic rather than neuropathic and does not disappear by mandibular branch block. According to its pain location, nature, number of episodes, duration and triggers, its diagnosis is not difficult after excluding cranial occupying lesions. In terms of pathogenesis, there are such theories as viral infection theory, focal theory, ischemia theory, cervical nerve theory, genetic theory, metabolic theory, etc. (a) First-line antiepileptic drugs: carbamazepine, second-line drugs: baclofen, lamotrigine, oxcarbazepine, phenytoin sodium, gabapentin, pregabalin, and sodium valproate. (ii) Small doses of antidepressants have been used effectively for the treatment of neuralgia, but are controversial, e.g., duloxetine, mainly used in patients with neuralgia combined with depression. (c) Opioids, such as morphine and oxycodone, can effectively control neuralgia, and the effect is more obvious when combined with gabapentin. (iv) Gallium maltolate emulsion or ointment has been reported to reduce herpes zoster virus-related trigeminal neuralgia. (a) Microvascular decompression, the purpose of which is to relieve the compression of the nerve root by the responsible blood vessels, by opening a hole in the skull behind the ear on the painful side, with a diameter of about 25 mm, exposing the nerve out of the brainstem, freeing the blood vessels in close contact with the nerve root, and freeing the nerve root. The vessel in close contact with the root is freed and isolated with a spacer. MVD provides long-term pain relief, with occasional cases of recurrence, and there are some risks associated with MVD, such as rare complications of hearing loss, facial nerve palsy, facial numbness, diplopia, and stroke. The surgical efficiency is up to 90% or more for those who are experienced in surgery. (b) Stereotactic radiosurgery, which uses cluster rays to destroy the trigeminal nerve to relieve and eliminate pain. The pain is often relieved gradually over several weeks. The effectiveness of the treatment decreases with time. If there is a recurrence, radiation therapy again is still effective. There is a tendency to replace surgical treatment because it is safer and more effective than other means. (c) Glycerol injection (glycerolrhizotomy), a small amount of sterile glycerol is injected into the trigeminal nerve hemimelia (Meckel’s capsule) through a fine needle through the face, and the nerve is moderately destroyed to block the nociceptive signal transmission, which usually relieves the pain, but some patients have recurrence and facial numbness and tingling. (d) Balloon compression, in which a hollow needle is punctured along the base of the skull near the trigeminal nerve and a balloon catheter is introduced through the puncture needle at the cephalic end to destroy the nerve by moderate inflation and block the nociceptive signal transmission. Most of the pain can be relieved after treatment, but some patients will have transient or even long-term chewing weakness, which is suitable for the old and frail, especially for patients with combined ophthalmic neuralgia; (e) radiofrequencyrhizotomy, the basic operation is the same as balloon compression, insert an electrode to the vicinity of the target nerve, and selectively destroy the trigeminal nerve tissue by heating the electrode. For atypical trigeminal neuralgia, the above treatment is also effective, but the success rate is relatively lower. For this disease, our hospital mainly adopts MVD surgery, which is guaranteed by solid theoretical foundation and rich surgical experience, and the patient’s pain is relieved immediately after surgery. The patient’s “Thank you!” made us feel proud to be doctors again. We hope that we can relieve the pain of more patients with our modest power. ”Health is important, life is important”