Objective To investigate the value of three-dimensional time-of-flight magnetic resonance angiography （3D-TOF-MRA） combined with intraoperative neurophysiological monitoring （IONM） in microvascular decompression for neurovascular compression syndrome.Methods A total of 218 patients with neurovascular compression syndrome who were admitted to our hospital from August 2016 to November 2018 and planned to undergo microvascular decompression were enrolled and randomly divided into study group and control group， with 109 patients in each group. All patients received 3D-TOF-MRA before surgery， and IONM was performed for the patients in the study group during surgery. The two groups were compared in terms of surgical outcome， postoperative complications， and recurrence rate at 2 years after surgery.Results Compared with the control group， the study group had significantly higher overall response rates of patients with trigeminal neuralgia （100.00% vs 90.91%， P <0.05） and patients with hemifacial spasm （100.00% vs 89.19%， P <0.05）， and there was no significant difference in the good response rate of patients with glossopharyngeal neuralgia between the study group and the control group （100.00% vs 93.75%， P >0.05）. The study group had a significantly lower incidence rate of total postoperative complications than the control group （4.12% vs 14.43%， P <0.05）. There was no significant difference in recurrence rate at 2 years after surgery between the study group and the control group （P >0.05）.Conclusions In microvascular decompression for neurovascular compression syndrome， 3D-TOF-MRA combined with IONM can improve surgical outcome and reduce postoperative complications. ［Journal of International Neurology and Neurosurgery：2021, 48(1): 27-31］