To explore the safety and efficacy of neuronavigation and C-arm-assisted percutaneous balloon compression (PBC) and microvascular decompression (MVD) in treating trigeminal neuralgia. Meth? ods: Clinical data of 144 patients treated for trigeminal neuralgia at our hospital were retrospectively collected. Patients were divided into the MVD group (n=76) and PBC group (n=77) based on method of treatment. Preoperative factors, postoperative efficacy and complications, length of hospitalization, and duration of operation were analyzed and compared between the two groups. Results: The patients in PBC group were older than the patients MVD group (P<0.05). There was no statistical difference in the pain relief rate of the two groups immediately, 6 months, and 1 year after surgery (all P>0.05). In patients aged>60, the postoperative pain relief rate after PBC was higher than that after MVD (P<0.05). The two groups showed differences in postoperative complication. The incidence of vertigo was 60.0% in the MVD group, significantly higher than that in the PBC group (P<0.05). In the PBC group, the incidence of facial numbness (52.6% ), masticatory muscle disorder (40.2% ), and herpes (7.79%) were significantly higher than those in the MVD group (all P<0.05). Operation time and hospitalization time were both significantly lower in the PBC group compared to the MVD group (all P<0.05). Con? clusion: PBC and MVD show similar efficacy in the treatment of trigeminal neuralgia but show differences in postoperative complications. In the elderly, PBC is the more suitable procedure.