Trigeminal neuralgia is the most common form of neuralgia, with recurrent episodes of transient and severe pain confined to one or several branches of the trigeminal nerve. The typical characteristics of trigeminal neuralgia are: 1) paroxysmal, electric shock-like pain in the distribution area of the trigeminal nerve on one side of the face; 2) a distinct “trigger point” that triggers pain upon stimulation; 3) a distinct remission and exacerbation period; it occurs mostly in adults and the elderly, with an annual incidence of 3-5 per 100,000 people and a prevalence of 182 per 100,000 people. The exact cause of the disease is still unclear. The early stage of the disease is mainly treated with carbamazepine-based drugs, and the dose of drugs needs to be gradually increased during the treatment process. For patients who do not respond to drug therapy or who experience significant adverse drug reactions due to increased drug doses, other treatments such as closure therapy, acupuncture, percutaneous trigeminal ganglion disruption (radiofrequency thermocoagulation, balloon compression or glycerol injection), trigeminal nerve microvascular decompression or partial posterior rhizotomy, and gamma knife therapy may be used instead. Comparative studies on the long-term efficacy of trigeminal neuralgia treatment have shown that microvascular decompression and trigeminal ganglion percutaneous radiofrequency thermocoagulation are the most desirable treatments. Microvascular decompression may provide longer pain-free survival with fewer complications and higher quality of life than other surgical options, whereas percutaneous trigeminal ganglion radiofrequency thermocoagulation is more suitable for elderly patients who are less tolerant of open surgery. Transcutaneous trigeminal ganglion radiofrequency thermal coagulation is an effective and safe treatment method with the advantages of small trauma, precise efficacy, short operation time, less cost and short hospital stay. The neurosurgery department of Qilu Hospital of Shandong University has been carrying out this treatment for more than 20 years, and now it has become a characteristic and advantageous treatment project of our hospital. However, this treatment can cause severe pain similar to trigeminal neuralgia attack, which some patients cannot tolerate; in addition, there is a potential risk of cardiovascular accidents due to increased heart rate and blood pressure during the treatment. In order to reduce patients’ pain during the treatment process and reduce the risk of complications of cardiovascular accidents during the treatment process, our neurosurgery department and anesthesia department jointly conducted a clinical study on painless radiofrequency treatment of trigeminal neuralgia. The operation was performed in the hybrid operating room of our hospital. The patient was firstly sedated and anesthetized with consciousness, and then a puncture of the oval foramen on the affected side was performed, and the puncture process was localized with X-ray assistance. The patient remained awake during the whole process and was able to cooperate with electrophysiological positioning, and the heart rate and blood pressure were able to maintain relative stability. On the one hand, this method can reduce the pain of patients undergoing radiofrequency treatment; on the other hand, because of the painless technology, it can guarantee the adequate thermal coagulation and destruction of the trigeminal ganglion during the treatment, reducing the interruption of treatment due to the patient’s intolerance of pain, thus improving the efficacy, and safety of the procedure. At present, the neurosurgery department has successfully treated 18 patients with trigeminal neuralgia by adopting this procedure, which has shortened the hospital stay and reduced the financial burden of the patients with remarkable efficacy, and has been unanimously praised by the patients and their families.