Trigeminal Neuralgia (TN), also known as Tic douloureux, is divided into two types: primary and secondary, and presents with recurrent episodes of transient paroxysmal pain in the trigeminal nerve distribution of the face. The disease is not uncommon, and epidemiological surveys abroad show that the incidence is about 5/100,000 population/year. Due to the huge population base in China, there are a large number of trigeminal neuralgia patients seeking effective ways to relieve their pain every year. Facial pain caused by secondary trigeminal neuralgia with clear etiology, such as tumor, vascular lesion or skull base malformation, which compresses and stimulates the trigeminal nerve, needs to be treated for the primary lesion and is not part of the discussion of this article. This article focuses on the minimally invasive surgical treatment of primary trigeminal neuralgia. There are various speculations on the etiology of primary trigeminal neuralgia, and the most popular theory is that due to demyelinating lesions of some nerve fibers in the sensory afferent pathway of the trigeminal nerve, the afferent nerve impulses are short-circuited, allowing non-injurious sensory impulses to trigger an injurious pain response. In a section of the trigeminal nerve about 1 cm anterior and posterior to the pontine brain, the myelin sheath of afferent nerve fibers changes from a peripheral to a central structure, and the myelin sheath at this site may be more fragile and sensitive to external pressure. There is now abundant evidence that the blood vessels passing through this area, especially the tortuous arteries, can exert pressure on the trigeminal nerve into the pontocerebral region and cause demyelination of nerve fibers, which is the main cause of trigeminal neuralgia. For patients with initial trigeminal neuralgia, medication is still the preferred method and a necessary screening tool. It is important to take medication and actively perform the necessary tests to exclude secondary trigeminal neuralgia caused by tumors and other etiologies. It is important to note that there is no drug treatment that can cure trigeminal neuralgia, and most patients will experience a gradual decrease in pain control after long-term medication, and sooner or later, intolerable drug toxicities will occur. Since Jannetta advocated trigeminal nerve microvascular decompression in 1967, it has been gradually accepted and widely used by neurosurgeons around the world. 30 years of experience shows that trigeminal nerve microvascular decompression is the only surgical treatment that can cure primary trigeminal neuralgia with high efficiency and low recurrence rate, and can preserve the normal function of the trigeminal nerve. It is the only surgical treatment method that can cure primary trigeminal neuralgia while preserving normal facial sensation. Although primary trigeminal neuralgia is extremely painful, the disease itself does not lead to life-threatening changes in other organs and systems. Although microvascular decompression is a mature procedure with a history of more than 30 years, it is less invasive and has fewer complications, but still carries certain surgical risks. In order to improve the cure rate and reduce the risk of surgery, we must strictly control the indications for surgery. The current indications for our trigeminal nerve decompression surgery are: 1. Patients with diagnosed primary trigeminal neuralgia; 2. Patients who are not satisfied with the effect of medication or cannot tolerate the side effects of medication; 3. Patients who are usually under 65 years of age. The following patients should be considered as contraindications for surgery: 1. Patients with facial pain not yet excluded from secondary trigeminal neuralgia; 2. Patients with severe systemic diseases such as severe hypertension, heart disease, or important organ damage; 3. Patients with disorders of coagulation mechanism and bleeding tendency. 4.Patients who have been clearly diagnosed with multiple sclerosis. Patients with a general history of chronic diseases such as hypertension, heart disease, and diabetes should be considered for surgery after satisfactory control of their condition with regular medical treatment. For those aged 65 years or older, if they can tolerate the surgery, part of the trigeminal sensory roots are usually cut off at the same time of vascular decompression to reduce the possibility of recurrence. For patients who are not suitable for trigeminal nerve manifest microvascular decompression, there are other treatment options that can be considered, such as radiofrequency electrocoagulation selective destruction of the trigeminal hemimelia, glycerol injection destruction of the posterior root of the trigeminal hemimelia, balloon compression of the trigeminal hemimelia, and tearing of the peripheral branches of the trigeminal nerve. In recent years, there have been many reports on the use of stereotactic radiotherapy (gamma knife or X-ray knife) techniques for the treatment of primary trigeminal neuralgia. The use of focused gamma rays or X-rays to irradiate the entrance site of the trigeminal nerve into the pontine brain has a recent efficiency of about 50%, and the long-term effects are yet to be studied in follow-up studies, which will not be discussed here. In addition to routine blood, urine and stool tests, electrocardiogram, ultrasound and chest X-ray, the most important special examination is CT or MR scan of the posterior cranial recess to exclude secondary trigeminal neuralgia caused by tumors, vascular malformations and other lesions. High-resolution MR thin-layer scans and 3D reconstruction can also detect abnormal arterial compression near the trigeminal nerve root. The recent efficiency of trigeminal nerve microvascular decompression can be more than 90%, after which there are recurrence cases year by year, and the recurrence rate is about 2% per year after surgery, and the cure rate is about 80% at 5 years and 70% at 10 years. In cases of ineffective or recurrence after microvascular decompression, we usually operate again as long as the general condition of the patient allows. In about 50% of such patients, missed responsible vessels, newly formed vascular compressions, or pads that are too close to the nerve root and create new compressions on it can be found, and good results can be obtained by releasing the compressed part of the trigeminal nerve root. In some patients without any visible compression of the nerve root, partial sensory root dissection can provide pain relief in more than 90% of patients. In conclusion, trigeminal nerve decompression by microperforation is a fairly safe procedure with minimal trauma, rapid patient recovery, and preservation of trigeminal nerve function. Long-term follow-up results prove that this procedure is the best method for treating primary trigeminal neuralgia.