Objective To investigate the efficacy of microvascular decompression （MVD） in the treatment of trigeminal neuralgia and related recurrence factors and reoperation strategies.Methods A total of 256 patients with trigeminal neuralgia who received MVD in Department of Neurosurgery， Changsha Central Hospital Affiliated to Nanhua University， from October 2017 to August 2020 were enrolled， and the patients were followed up for 6 months to analyze clinical outcome， recurrence factors， and reoperation strategies.Results Among the 256 patients， 223 （87.1%） were completely cured， 15 （5.9%） were improved， 6 （2.3%） were not cured， and 12 （4.7%） experienced recurrence. The overall response rate was 93.0% （238/256）， and the non-response rate was 7.0% （18/256）. The 18 patients with no response were followed up for 6 months after the second operation， among whom 17 achieved remission and 1 had no response to balloon compression of the trigeminal semilunar ganglion. The statistic analysis showed that age， neurovascular impression， and type of vascular compression were the risk factors for recurrence of trigeminal neuralgia after MVD （P <0.05）.Conclusions MVD has a marked clinical effect in the treatment of trigeminal neuralgia， and postoperative recurrence factors and reoperation strategies should be analyzed and taken seriously.