To retrospectively analyze the safety, efficacy, and long-term curative effect of spiral CT-guided pulse radiofrequency (PRF) therapy on gasserian ganglion for trigeminal neuralgia (TN). Methods: The medical data of 121 classic TN patients who underwent gasserian ganglion PRF treatment were analyzed, and preoperative and postoperative BNI pain intensity were compared. Data on perioperative complications were retrospectively collected, and the Kaplan-Meier analysis was used to evaluate pain recurrence and long-term curative effect. Results: The initial pain relief rate was 85.12%, and the cumulative recurrence-free survival after the procedure was 85.12%, 82.62%, 78.98%, 70.47%, 63.98%, and 61.08% at 1, 6, 12, 48, 96, and 120 months, respectively. There were no adverse complications noted during treatment. Conclusion: Spiral CT guided gasserian ganglion PRF treatment for classic TN is safe, effective and has few side effects. It is suitable for elderly patients with multiple comorbidities who cannot tolerate general anesthesia.