Trigeminal neuralgia (TN) is the most common facial neuralgia, and is extremely painful. We evaluate the effectiveness of percutaneous controlled radiofrequency trigeminal rhizotomy (RFTR) assisted by a virtual reality (VR) imaging technique for idiopathic TN. A total of 2769 patients with TN underwent RFTR procedures between June 1986 and March 2007, with VR assisted guiding and electrode positioning in 26 patients from January 2006 to March 2007. A laminal basicranial CT scan (2 mm slice, 16 slices/s) was used during RFTR. The three-dimensional (3D) position of the electrode needle tip and the oval foramen can be seen clearly using this VR technique. The position and depth of the needle was adjusted according to the virtual 3D-CT scan. CT scanning was performed repeatedly until the needle tip was situated in the oval foramen. Usually, the tip of the electrode was adjusted once or twice. Acute pain relief was accomplished in the 26 patients who underwent a single RFTR procedure assisted with VR. No recurrence of pain was noted except in one patient after 16 months. There were no permanent complications or mortality. VR-assisted RFTR represents a minimally invasive, low-risk technique with a higher efficacy compared with traditional RFTR.