Microvascular decompression (MVD) surgery has been popularized as an etiological treatment around the world for more than half a century. However, as a functional operation in the cerebellopontine angle, this process should be refined to enhance cure and minimize complication. After accomplishing more than 10,000 MVDs, we have learned the following concerning the operative technique: (1) the principle of MVD is to separate the neurovascular confliction, rather than isolate with prostheses;(2) identification of the conflict relies on good exposure; (3) a satisfactory working space can be created by the appropriate positioning, i.e., either a close-to-the-sigmoid craniectomy or caudorostral approach; (4) a sharp dissection of arachnoids leads to a maximal visualization of the entire intracranial course of the nerve root; (5) all vessels contacting the trigeminal nerve root should be cleared off; (6) intraoperative electrophysiological monitoring may predict the prognosis of hemifacial spasm and guide the operation; and (7) the dura must be closed with watertight stitches at the end.
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