Objective to explore the clinical significance of hybrid operating room DSA combined with 3D reconstruction in trigeminal nerve minimally invasive puncture balloon compression. Methods the clinical data of 15 cases of trigeminal neuralgia treated by percutaneous balloon compression under the guidance of hybrid operating room DSA and 3D reconstruction from January 2019 to January 2021 were analyzed retrospectively. The puncture times, intraoperative balloon shape, postoperative clinical efficacy and the incidence of complications were evaluated. Results 14 patients were successfully punctured once, 1 patient was punctured twice, and the success rate was 93.3%. During the operation, the balloon was pear shaped in 13 cases, pear like in 2 cases, the postoperative symptoms completely disappeared in 13 cases, and significantly relieved in 2 cases. There were no other complications of cranial nerve injury, intracranial hemorrhage and intracranial infection. Conclusion hybrid operating room DSA combined with 3D reconstruction technology can effectively assist accurate puncture and improve the success rate of operation, which has important clinical significance.