Objective: To investigate the clinical significance of hybrid operating room DSA assisted three-dimensional reconstruction in minimally invasive puncture and balloon compression of trigeminal nerve. Methods: The clinical data of 15 patients with trigeminal neuralgia who were treated by percutaneous puncture and balloon compression with DSA assisted three-dimensional reconstruction technology from January 2019 to January 2021 were retrospectively analyzed. The puncture times, balloon shape during operation, clinical efficiency after operation and incidence of complications were evaluated. Results: 14 patients were punctured successfully for the first time, 1 patient was punctured twice, and the first success rate was 93.3%. During the operation, 13 patients had pear shaped balloons, 2 patients had pear shaped balloons, 13 patients had completely disappeared symptoms after the operation, 2 patients had significant relief, no other complications of cranial nerve injury, no intracranial hemorrhage, no intracranial infection and other complications. Conclusion: DSA assisted 3D reconstruction technology can effectively assist precise puncture, improve the success rate of surgery, and has important clinical significance.