Objective To investigate the efficacy and safety of robot-assisted percutaneous balloon compression (PBC) for treating trigeminal neuralgia (TN). Methods A total of 120 patients who underwent PBC at our hospital from December 2021 to December 2024 were selected as the study subjects and divided into two groups based on the type of assistance used: the robot-assisted group (n=52) and the DSA group (n=68). Patient data were collected, and comparisons were made between the two groups regarding hemodynamic parameters at five time points, NRS scores before and at 1 day, 7 days, 1 month, 3 months, and 6 months after surgery, improvement rates of NRS scores, oral analgesic use at 6 months postoperatively, clinical efficacy rates, subjective facial numbness grades, superficial sensation reduction grades, masseter muscle strength grades before and at 6 months after surgery, and complications at 6 months postoperatively. Results No significant differences were found between the robot-assisted group and the DSA group in terms of hemodynamic parameters at the five time points, NRS scores before and at 1 day, 3 months, and 6 months after surgery, improvement rates of NRS scores, oral analgesic use at 6 months postoperatively, clinical efficacy rates, subjective facial numbness grades, superficial sensation reduction grades, and masseter muscle strength grades before and at 6 months after surgery, as well as complications at 6 months postoperatively (P>0.05). However, the robot-assisted group had lower NRS scores at 7 days and 1 month after surgery compared to the DSA group, with statistically significant differences (P<0.05). Conclusion Robot-assisted PBC patients has stable intraoperative hemodynamic parameters, faster postoperative recovery and pain relief, and no severe complications related to puncture such as diplopia or vascular injury. The procedure is highly accurate, safe, and reliable, with high efficacy and safety rates comparable to those of DSA-guided PBC. It can be applied and promoted in clinical practice