Both trigeminal neuralgia and facial spasm are relatively common disorders, and conventional conservative treatment is often ineffective. Microvascular decompression of the posterior cranial fossa, a minimally invasive locked-hole microneurosurgery, is an effective and safe treatment for trigeminal neuralgia and facial spasm. The incidence of trigeminal neuralgia is 3-6 per 100,000 people, and there are 2 types of trigeminal neuralgia, primary and secondary. Secondary trigeminal neuralgia is mostly caused by localized occupying lesions in the posterior cranial fossa such as tumors, aneurysms, arteriovenous malformations, granulomas, etc., which can be cured by surgical removal of the lesions. About 60% of patients who visit neurosurgery for facial pain have primary trigeminal neuralgia. This disease is characterized by paroxysmal pain on one side of the face, like cutting, burning, stabbing or electric shock, which lasts for a few seconds to a few minutes and then stops abruptly; the pain is limited to the distribution area of the trigeminal nerve, often located in the upper lip, nose, corner of the mouth, incisors and buccal mucosa; it can be triggered by touching the face, expression changes, eating, drinking, brushing teeth, gargling, etc.; the severe pain causes great suffering to patients and seriously affects their quality of life. . The current consensus on the etiology of primary trigeminal neuralgia is that the intracranial segment of the trigeminal nerve is compressed by abnormal blood vessels. The usual conservative treatments such as oral medications, acupuncture, nerve closure and nerve destruction are ineffective or prone to recurrence. Microvascular decompression surgery is performed by opening the trigeminal nerve root through a small bone window (1.5 cm in diameter) with a minimally invasive locking hole in the posterior cranial fossa behind the ear, and releasing the compression by pushing the compressed blood vessel away from the root of the trigeminal nerve with a pad made of special material. Surgical method: General anesthesia with endotracheal intubation, with the affected side lying in an upward lateral position, head dropping 15° and rotating 10° to the healthy side, and neck slightly flexed forward so that the affected mastoid is in the highest position of the head. The length of the incision depends on the extent of the patient’s cranial nerve disorder and the length and thickness of the occipital neck. The diameter of the open bone window is 1.5 cm. The upper edge reaches the level of the transverse sinus, the anterior edge approaches the sigmoid sinus, and the lower edge reaches 1.5 cm below the transverse sinus. after the dural incision, the cerebrospinal fluid is slowly drained under the operating microscope. The cerebral pressure plate should be gradually retracted and deepened, the nerve root and the arachnoid membrane covering the dorsolateral surface of the pontine brain should be cut, and a narrow 2 mm wide cerebral pressure plate at the front should be placed on the surface of the cerebellum and retracted, and electrocoagulation should be applied to cut off the thick rock vein or pontine vein when it obstructs the access. The trigeminal nerve root enter zoon (REZ) is explored, and the responsible vessel is carefully identified, then the responsible vessel is free by sharp stripping method and pushed away from the REZ for full decompression. Afterwards, the surgical field is thoroughly hemostatic, adequately flushed, the dura is tightly sutured, and the skull is routinely closed. If no clear vascular compression is found during surgery, the trigeminal sensory root can be partially severed, which can also achieve pain relief. The overall efficiency of microvascular decompression in the treatment of trigeminal neuralgia is about 90%, and in a small number of patients with recurrence of pain after surgery, reoperation is equally effective. The incision is only 3 cm long, and the wound sutures can be removed 7 days after surgery. Complications of surgery include cerebrospinal fluid leakage, incision infection, and intracranial infection, all of which have a low incidence, and others such as hearing impairment and facial palsy are even less common. Facial muscle spasm refers to paroxysmal, involuntary muscle spasms 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. Facial muscle spasm affects the patient’s appearance and causes inconvenience to daily life and work. Conventional conservative treatment is ineffective or recurrent. Microvascular decompression is the only known cure for this disease. Like trigeminal neuralgia, the cause of facial myospasm is the compression of the facial nerve root by localized abnormal blood vessels in the skull. Therefore, the treatment can be achieved by applying microvascular decompression to open the compressed vessels. The location, size and postoperative complications of the surgical incision are similar to those of trigeminal neuralgia, but the incidence of postoperative hearing impairment is slightly higher, but most patients can recover, and permanent hearing loss on one side is rare. The overall efficiency of this surgery for facial spasm can be more than 95%, and there is a 2-3% recurrence rate after surgery. In the 1970s, an American neurosurgeon first reported the use of microvascular decompression to treat trigeminal neuralgia and facial myospasm, and obtained satisfactory treatment results. The neurosurgery department of Shengli Oilfield Central Hospital has been carrying out microvascular decompression since 2006, with satisfactory surgical results and minimal complication rate. With the advancement of micro-neurosurgical skills and experience, the surgical efficacy will be further improved and the complication rate will be decreased, which will relieve the pain of more patients with trigeminal neuralgia and facial spasm.