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.