脑神经血管压迫综合征以经典型三叉神经痛、特发性面肌痉挛和舌咽神经痛为主要代表，显微血管减压术（MVD）是其重要的病因性外科治疗手段。随着MVD广泛开展，临床实践中仍存在手术指征泛化、责任血管识别不足、减压不充分、术中监测应用不规范及基层质量控制体系不完善等问题。本文围绕脑神经MVD的手术指征、有效减压、术中神经电生理监测、疑难病例分层处理，及规范化推广与质量控制进行述评，旨在推动MVD由单纯普及应用转向以长期疗效、低复发率、低并发症率和诊疗同质化为核心的高质量发展。

Cranial neurovascular compression syndromes are mainly represented by classical trigeminal neuralgia, idiopathic hemifacial spasm, and glossopharyngeal neuralgia. Microvascular decompression (MVD) is an important etiological surgical treatment for these disorders. With the widespread application of MVD, several problems remain in clinical practice, including overly broad surgical indications, insufficient identification of offending vessels, inadequate decompression, nonstandard application of intraoperative monitoring, and incomplete quality control systems at primary medical institutions. This article reviews the surgical indications, effective decompression, intraoperative neurophysiological monitoring, stratified management of difficult cases, standardized dissemination, and quality control of MVD for cranial nerves, aiming to promote the transition of MVD from simple widespread application to high-quality development centered on long-term efficacy, low recurrence rates, low complication rates, and homogeneous diagnosis and treatment.