Objective Exploring the relationship between pain recurrence after percutaneous radiofre-quency thermocoagulation and the degree of trigeminal nerve atrophy and pontine angle in patients with primary trigeminal neuralgia(INT).Methods A retrospective analysis was conducted on 297 patients with INT admitted to Qingdao Haici Hospital Affiliated to Qingdao University(Qingdao Traditional Chinese Medicine Hospital)from January 2020 to December 2021.All patients received percutaneous radiofrequency thermocoagulation surgery in our hospital.They were followed up for 24 months,during which 56 patients experienced pain recurrence after sur-gery(recurrence group),while 241 patients did not experience postoperative pain recurrence(non-recurrence group).Results The length of the trigeminal nerve root,degree of trigeminal nerve atrophy,and the combined application of the two were used to draw ROC curves.The AUC values predicted for pain recurrence in INT patients after percutaneous radiofrequency thermocoagulation were 0.553,0.750,and 0.861,respectively.The results of the logistic regression model showed that shortened trigeminal nerve root length(OR=0.624,P=0.038),increased degree of trigeminal nerve atrophy(OR=2.257,P=0.000),multi vessel compression(OR=1.842,P=0.019),and severe baseline pain(OR=1.714,P=0.000)were independent risk factors for pain recurrence in INT patients after percutaneous radiofrequency thermocoagulation(P<0.05).Conclusions INT patients undergo thin-layer MRI scans before surgery,and the degree of trigeminal nerve atrophy has a higher predictive value for pain recur-rence after radiofrequency thermocoagulation.The length of trigeminal nerve roots and degree of trigeminal nerve atrophy are correlated with postoperative pain recurrence in patients.