Hemifacial spasm （HFS） is a common cranial nerve disorder characterized by the benign， chronic， and involuntary twitching of facial muscles， and it often starts from the unilateral orbicularis oculi and gradually affects other facial expression muscles on the same side. Currently the pathogenesis of HFS remains unclear， but it is widely accepted that it is caused by demyelination changes due to neurovascular compression at the root exit zone （REZ） of the facial nerve. Microvascular decompression （MVD） is considered the gold-standard treatment method for primary HFS， and the development and practice of neuroimaging， neuroanatomy， electrophysiology， and technical equipment further improve the functional protection of neurovascular structures during MVD surgery， thereby enhancing the safety and effectiveness of HFS-MVD. This article introduces the main clinical research advances in HFS-MVD from the aspects of the pathogenesis， preoperative evaluation， electrophysiological monitoring， surgical techniques， and postoperative prognosis of HFS-MVD. ［Journal of International Neurology and Neurosurgery, 2024, 51(5): 98-104］