Objective To explore the therapeutic effect and safety of microvascular decompression ( MVD) and gamma knife surgery ( GSK) in primary trigeminal neuralgia． Method 50 PTN patients were divided into 2 groups according to its treatment method: 22 were treated with MVD and the other 27 were treated with GKS． Effectiveness，complication and recurrence of the two groups were measured and analyzed． Result 46 patients in total were followed up for 10 to 70 months，21 in MVD group，and 25 in GSK group． The two group had statistically significant difference in the grade of total pain relief ( P = 0． 021) and in the cure rate ( P = 0． 021) ，with the rate higher in MVD group． The difference was not statistically significant in the total effectiveness，though the MVD group’s was higher than the GKS group’s． The effectiveness difference between the two groups within 1 month ( P = 0) and within 3 month ( P = 0． 028) had statistic significance． Pain relief rate of half a year，one year，and the last time follow-up in MVD group were higher than those in GKS，respectively，but without statistical significance． There was no statistical significant difference in complication between the two groups． Recurrence rate in MVD group was lower than in GKS ( 4． 8% vs 16． 0%) ，but with no statistical significance． Conclusion While both MVD and GSK can relieve the pain of PTN，MVD has its advantage over GSK in the cure rate and the short view，indicating it as a priority for the majority of patients． Meanwhile，GSK may be a wise choose for the aged with bad physical condition or people who can’t tolerate surgery or anesthesia．

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