Objective To summarize the curative effect and surgical skills of microvascular decompression( MVD) via keyhole for the treatment of cranial neuropathy. Methods Totals of 513 cases of primary cranial neuropathy under MVD treatment between January 2005 and January 2016 were retrospectively analyzed， which included 263 trigeminal neuralgia cases， 234 hemifacial spasm cases and 16 glossopharyngeal neuralgia cases. The surgical techniques and prevention of postoperative complications were analyzed. Results There was no death or other severe complications in our group．The postoperative cure rate with trigeminal neuralgia was 94.67％，97.01% with hemifacial spasm and 75.00% with glossopharyngeal neuralgia. Conclusions MVD is a reliable method for primary cranial neuropathy，what is more， skilled microsurgical techniques， rich microsurgical experience and familiarity with the anatomy are the foundation of the surgical treatment for cranial neuropathy.