Trigeminal neuralgia is a unique chronic painful disorder that is characterized by transient, paroxysmal, recurrent episodes of severe electric shock-like pain in the distribution area of the trigeminal nerve, or with ipsilateral facial muscle spasm or facial paralysis. The disorder is more common in middle-aged and elderly people, with 70% to 80% of patients over 40 years of age, more women than men, and its onset on the right side than on the left side. It starts with a sudden onset of transient paroxysmal lightning-like pain in the trigeminal nerve distribution of the patient’s face for no reason. The tendency of the pain episodes is mostly mild at first, with fewer episodes and longer intervals, and there may be a considerable period of remission, which may last for weeks, months, or even years. In most patients, as the disease progresses, the pain attacks become more frequent and the pain becomes more intense. As a result, the patient’s appetite is severely affected, and he or she gradually becomes thin and weak, mentally weak, directly affecting work and study, and even losing the ability to work. The patient’s expression is very painful and he is in fear of the next attack all day long. In addition, the patient has sought multiple treatments with poor results and has a history of pain for years and decades. Most clinical data indicate that vascular compression of the trigeminal nerve roots is the main cause of primary trigeminal neuralgia; Dandy found trigeminal neuralgia by posterior cranial fossa approach in about half of the patients with vascular contact and compression of the trigeminal nerve roots; Jannetta relieved vascular compression at the entrance of the trigeminal nerve bridge in patients with trigeminal neuralgia and the trigeminal neuralgia symptoms disappeared after surgery; in addition, autopsy and MRI showed that trigeminal nerve was vascularly compressed at the cerebral bridge appendage in 85% of patients, most commonly by arterial compression, and venous compression was rare. In branch 2 and 3 pain, the superior cerebellar artery is usually found to compress the cephalic upper part of the trigeminal nerve; in branch 1 pain, it is usually the anterior inferior cerebellar artery that compresses the caudal lower part of the trigeminal nerve. Diagnosis of primary trigeminal neuralgia The diagnosis of patients with primary trigeminal neuralgia can be made by detailed questioning of the patient’s medical history, pain location, nature of pain and other clinical manifestations. In addition, the examination reveals that most patients have a thinner general condition due to the long-term effects of eating. Painful expressions, greasy face and reluctance to speak during painful episodes, and even in the interval patients are reluctant to speak or rarely speak. However, the neurological examination of the patient was normal, and there were no obvious abnormal changes in various sensory and motor sensations of the trigeminal nerve, corneal reflexes, and mandibular reflexes. In some patients, the local pain and sensation in the face is reduced due to previous treatment, which should be differentiated from the facial hyperalgesia caused by secondary trigeminal neuralgia. The skull base radiograph shows no pathological changes in the foramen ovale and foramen ovale. In conclusion, based on the location and nature of pain, without other neurological symptoms and signs, the diagnosis of trigeminal neuralgia is generally not difficult. It is generally believed that the diagnosis of trigeminal neuralgia should have the following characteristics: 1. gender and age: the age is mostly above 40 years old, with more middle-aged and elderly people. There are more women than men, about 3:2. 2. Pain site: more on the right than on the left, and the pain starts from a point on the face, mouth or jaw and spreads to one or more branches of the trigeminal nerve, with the second and third branches being the most common, and the first branch being rare. The pain does not extend beyond the midline of the face and does not exceed the area of distribution of the trigeminal nerve. Occasionally, there is bilateral trigeminal neuralgia, accounting for 3%. 3.The nature of pain: such as inverted cutting, needling, tearing, burning or electric shock-like severe and unbearable pain, or even painful. 4, the pattern of pain: the attack of trigeminal neuralgia is often without warning, while the pain attacks are generally regular. Each pain attack lasts from only a few seconds to 1 to 2 minutes and stops abruptly. At the beginning of the disease, the number of attacks is small and the interval is long, ranging from several minutes to several hours, but with the development of the disease, the attacks become more frequent, the interval is gradually shortened, and the pain is gradually aggravated and intense. The pain attacks decrease at night. There is no discomfort during the interval. 5, triggering factors: talking, eating, washing, shaving, brushing teeth and wind blowing can trigger a pain attack, so that the patient is on tenterhooks, depressed, careful and cautious actions, and even afraid to wash their faces, brush their teeth, eat, and speak carefully, for fear of causing an attack. 6, trigger point: trigger point is also known as “trigger point”, often located in the upper lip, nose, gums, corner of the mouth, tongue, eyebrows and other places. Light touch or stimulate the trigger point can stimulate pain attacks. 7. Expression and facial changes: During the attack, it often suddenly stops talking, eating and other activities, and the painful side can show spasms, i.e. “painful spasms”, frowning and clenching teeth, opening the mouth to cover the eyes, or rubbing the face with the palm of the hand to cause local skin roughness, thickening, loss of eyebrows, conjunctival congestion, tearing and salivation. The expression is mental tension and anxiety. 8, neurological examination: no abnormal signs, a few have facial hypesthesia. Such patients should be further questioned about their medical history, especially whether they have a history of hypertension, and comprehensive neurological examination, including lumbar puncture, skull base and internal auditory tract radiography, cranial CT, MRI, etc., if necessary, to help differentiate them from secondary trigeminal neuralgia. Microvascular decompression surgery for trigeminal neuralgia Trigeminal neuralgia is a common cranial nerve disorder that manifests as involuntary twitching or painful episodes on one side of the face. Modern medical research suggests that the main cause of these disorders may be the presence of abnormal blood vessels in the skull, causing compression of cranial nerve roots into the brainstem. Microvascular decompression (MVD) is a treatment technique that targets the cause of the disease and has become the preferred treatment method in the international arena. In recent years, with the advancement of minimally invasive surgical techniques and increased surgical safety, more and more patients are undergoing MVD surgery. The Department of Neurosurgery of Tongji Hospital of Tongji University carried out MVD surgery earlier in China, and after continuous improvement, a safe and reliable minimally invasive treatment technique has been formed. Advantages of the technology: ① Compared with non-surgical treatment methods, MVD surgery is the only treatment measure that targets the cause of the disease, so it is very effective and can be cured at once with few recurrences. ②Compared with traditional surgery, MVD surgery is a minimally invasive surgery, and the patient’s postoperative reaction is mild and recovery is fast. ③Surgical incision is small, no blood transfusion is needed, no shaved head is needed, and aesthetic and safety are high. ④Statistics show that the efficiency of surgery is 96%, which shows that the original symptoms are lifted or relieved, and the cure rate of atypical cases is also over 90%, and the cost of surgery is less.