Abstract The purpose of microvascular decompression surgery (MVD) was to obtain a perfect and permanent cure for hyperactive dysfunction of cranial nerves without causing complications and recurrences. From the experiences of long-term follow-up of a large series of patients with MVD for trigeminal neuralgia (TGN), hemifacial spasm (HFS) and glossopharyngeal neuralgia (GPN), the tactics for satisfactory treatment were described as follows: (1) correct diagnosis of symptoms, (2) correct identification of the offending vessel(s), (3) appropriate reposition of offending vessels (prosthesis should not be inserted between the nerve and the artery; the tough, arteriosclerotic offending vessel could be replaced by fixing its loop to the dura), (4) axis of the 5th cranial nerve should be straightened after decompression, (5) flocculus should be retracted in a perpendicular fashion to the axis of the 8th cranial nerve, together with an Auditory Brainstem Response (ABR) monitoring to preserve the 8th cranial nerve function. The delay of latency of the 5th wave of ABR should not exceed 1.0 ms and the reduction of amplitude should be less than 40% (critical limit), and (6) mastoid air cells should be carefully packed with bone wax and eye ointment wrapped in Surgicel (Ethicon, Somerville, NJ).