”Trigeminal neuralgia, sometimes called “facial pain,” is common in middle-aged and older patients. It is usually a recurrent, sudden, intense, and brief sharp pain that occurs unilaterally on the face. The pain comes on periodically and can be triggered by talking, brushing teeth, washing the face, or a breeze. Patients are often afraid to wipe their faces, eat, or even swallow saliva. It is easily confused with toothache, which often leads some patients to unnecessarily remove the normal teeth on the painful side. Because of the serious impact on patients’ life, some people jokingly call this pain the “world’s first pain”. Most of the patients with trigeminal neuralgia cannot find a clear cause in the past, so it is called primary trigeminal neuralgia. In the past, internal medicine has been applying drugs such as carbamazepine to treat the pain, which can often effectively relieve the pain symptoms at the beginning, but the effect often fades after long-term medication. Recently, more and more scholars believe that primary trigeminal neuralgia is caused by abnormal excitation of the trigeminal nucleus due to abnormal vascular compression of the trigeminal nerve in and out of the brainstem area. On this basis, microvascular decompression is gradually becoming the preferred surgical treatment for trigeminal neuralgia. Microvascular decompression is performed under general anesthesia by entering the cranium behind the affected ear and releasing the vascular compression of the trigeminal nerve under a microscope. Once the compression is released, the hyperexcitability of the trigeminal nucleus is then lost. In the vast majority of patients, the pain disappears immediately after surgery and normal facial sensation and function are preserved without affecting the quality of life. Due to the advantages of obvious pain relief, non-destructive, little side injury and very low recurrence rate, microvascular decompression is currently the safest and most effective method internationally recognized for the treatment of trigeminal neuralgia. Except for patients who cannot tolerate surgery, all other patients with trigeminal neuralgia are suitable for microvascular decompression surgery.