Objective: To explore the effects of microsurgical vascular decompression (MVD) and gamma knife respectively on the treatment of pain, anxiety and depression in patients with primary trigeminal neuralgia. Methods: From February 2011 to June 2017, we treated 108 patients with primary trigeminal neuralgia. According to the treatment plan of the patients, they were divided into an observation group and a control group, 54 cases each. The observation group underwent microsurgical vascular decompression (MVD) for the treatment of primary trigeminal neuralgia, while the control group received gamma knife treatment. The effects of pain, improvement of anxiety and depression were compared between two groups at 1 week, 3 months, and 6 months after treatment. Results: The pain, anxiety and depression scores of the observation group was significantly lower than that of the control group (P<0.05). Conclusion: MVD can relieve patients' pain, anxiety and depression symptoms, as well as improve quality of life and restore self-confidence in life.