Objective To assess the clinical application value of radiofrequency ablation (RFA) by using different-depth needle-puncturing through medial wall of oval foramen under fluoroscopic guidance in treating primary trigeminal neuralgia.Method A total of 32 patients with primary trigeminal neuralgia were enrolled in this study.Guided by fluoroscopic monitoring,RFA by using different-depth needle-puncturing through medial wall of oval foramen was carried out in all patients.The intraoperative exact replication rates of responsible nerve were recorded,and the postoperative one-day,one-week,3-month and one-year cure rates were calculated.Results During the operation,the precise replication rates the neuralgia of branch Ⅰ,branch Ⅱ and branch Ⅲ of the trigeminal nerve were 85.7％(6/7),96.4％ and 100％ respectively.The postoperative one-day,one-week,3-month and one-year cure rates were 87.5％,93.8％,93.8％ and 87.5％ respectively.Conclusion In treating trigeminal neuralgia with RFA,fluoroscopy-guided needle-puncturing through medial wall of oval foramen can accurately replicate the pain symptoms of the dominating region of responsible nerve,thus,the trigeminal neuralgia can be precisely treated.Being minimally-invasive and safe with reliable effectiveness,this technique is worthy of clinical application.