Objective To summarize the microvascular decompression(MVD)surgery of vertebrobasilar blood vessel for primary trigeminal neuralgia patients. Methods Clinical data of 28 primary trigeminal neuralgia patients caused by vertebrobasilar blood vessel from October 2008 to June 2016 in our hospital were retrospectively analyzed.There were 25 patients receving MVD and 3 patients receiving MVD and trigeminal sensory-root partial rhizotomy. Results The neuralgia in all the 28 patients immediately disappeared after surgery.Facial hypesthesia on the operation side occurred in 3 patients receiving MVD and trigeminal sensory-root partial rhizotomy.During follow-ups for 3 -24 months(mean, 18.6 months), none of the trigeminal neuralgia relapsed. Conclusions For primary trigeminal neuralgia patients caused by vertebrobasilar blood vessel, adequate nerve decompression and restoration of normal nerve anatomy are the guarantee for the efficacy of MVD surgery.For vessels with tensions and can not be passaged by one-time,multi-point decompression can complete the surgery.