Objective To evaluate the application value of three-dimensional computed tomography (3D CT) reconstructionguided percutaneous balloon compression (PBC) for primary trigeminal neuralgia (PTN). Methods A retrospective analysis was performed on 78 patients with PTN who underwent PBC under general anesthesia with digital subtraction angiography (DSA) guidance at Quanzhou First Hospital from November 2022 to July 2025. According to the different treatment methods, they were divided into two groups: the control group (n＝39, admitted from November 2022 to June 2024, undergoing surgery under traditional DSA guidance) and the observation group (n＝39, admitted from July 2024 to July 2025, with 3D CT reconstruction-guided PBC before the surgery). The differences in surgical-related indicators and clinical efficacy between the two groups were compared, and the occurrence of complications were recorded. Results The surgical-related indicators in the observation group were all significantly superior to those in the control group (all P＜0.05). The overall pain relief rate in the observation group after surgery was higher than that in the control group (P＝ 0.033), and the recurrence rate was lower during postoperative follow-up was lower than that in the control group (P＝0.047). Regarding complications, facial numbness occurred less frequently in the observation group after surgery (P＝0.044), while no significant differences were found for other complications (all P＞0.05). Conclusion Preoperative 3D CT reconstruction-guided PBC can streamline the surgical procedure, enhance puncture accuracy, reduce surgical trauma and radiation exposure, and at the same time help to lower the long-term recurrence rate and the incidence of some complications such as facial numbness.