【Abstract】 Objective To research the safety and effect of microvascular decompression (MVD) in patients with primary trigeminal neuralgia. Methods 76 primary trigeminal neuralgia patients were randomly divided into MVD group, PS group and PI group. MVD group (26 cases) was treated with MVD. PS group was treated with phenytoin sodium (21 cases). PI group (29 cases) was treated with lidocaine hydrochloride point injection. The treatment effects, the recurrence rate and mortality were observed. Results The efficiency of MVD group was much better than that of PS group and PI group (P＜005). The recurrence rate and mortality of MVD group, PS group and PI group had no significant difference (P＞005). Conclusion MVD for primary trigeminal neuralgia has obvious therapeutic effect and high security.