As an etiological treatment of trigeminal neuralgia, the microvascular decompression (MVD) surgery has been popularized 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 the cure rate and minimize the complication. After accomplishment of more than 6000 MVDs, we’ve learned something concerning the operative technique: (1) the principle of MVD is to separate the neurovascular confliction rather than isolation with prostheses; (2) identification of the conflict site is important, which relies upon a good exposure; (3) a satisfactory working space can be established by an appropriate positioning and a close-to-the-sigmoid craniectomy as well as a caudorostral approach; (4) a sharp dissection of arachnoids leads to a maximal visualization of the entire intracranial course of the nerve root; (5) all the vessels contacting the trigeminal nerve root should be treated; and (6) the dura should be closed with watertight stitches at the end. In this chapter, every single step of the procedure was detailed.