Recently, our department completed a case of trigeminal neuralgia combined with facial muscle spasm revealed by combined microvascular decompression. The patient, Pan, aged 47, was admitted to our neurosurgery department for 5 years because of recurrent left-sided head and facial pain, which had been aggravated for 3 months. His clinical symptoms were pinprick-like pain mainly on the left side of the frontal face, which was easily induced when shampooing teeth, washing face and combing hair, and occasionally accompanied by ipsilateral lateral muscle twitching, which seriously affected his quality of life. The disease was diagnosed as left-sided primary trigeminal neuralgia combined with facial muscle spasm, but the effect of previous drug treatment was not satisfactory. Trigeminal neuralgia is the most common of the neuropathic pain disorders. It often presents as sudden lightning-like attacks, such as pins and needles, knife cuts and electric shocks, which stop after a few minutes and recur. Treatment is based on conservative treatment with medication. For those who are ineffective in conservative treatment or have too many side effects after taking medication and cannot continue to take medication and can tolerate the risk of craniotomy, surgical treatment can be considered. On March 12, we successfully completed the microvascular decompression of trigeminal neuralgia combined with facial myoclonus under the small bone window through the posterior suboccipital sigmoid sinus. During the operation, it was found that the patient’s left trigeminal nerve and facial nerve were compressed by arterial collaterals respectively. Under the high-powered microscope, the arachnoid membrane around the neurovascular was carefully cut, the vascular collaterals were displaced, and the spacer was successfully placed to form a perfect anatomical decompression. On the same day after surgery, the patient Pan’s facial pain and twitching symptoms disappeared and he was discharged satisfactorily. Trigeminal nerve manifest microvascular decompression is the surgical method of choice for primary trigeminal neuralgia. The recent efficiency of the surgery can reach up to 90% or more, 70% can be maintained for 10 years, with few complications, small incidence of facial paralysis, and no painful sensory loss. Posterior sigmoid sinus 2×3cm bone window facial nerve surface compression vascular collaterals compression of facial nerve responsible vascular implantation spacer trigeminal nerve surface vascular collaterals compression trigeminal nerve responsible vascular implantation spacer postoperative review CT suggests surgical bone window 2.7cm postoperative review MRI