Objective To investigate the application value of magnetic resonance virtual endoscopy (MRVE) combined with three-dimensional time-of-flight (3D-TOF) and three-dimensional fast imaging employing steady-state acquisition (3D FIESTA) sequence in the microvascular decompression of trigeminal neuralgia. Methods Seventy-six patients with primary trigeminal neuralgia treated with microvascular decompression (MVD) at the Department of Neurosurgery, Huzhou Central Hospital from August 2012 to April 2015 were enrolled retrospectively. All the causes of disease in the patients were identified during the operations. All patients conducted imaging examinations of 3.0T MRI for 3D-TOF, 3D-FIESTA, and MRVE. The diagnostic and intraoperative values of MRVE combined with 3D-TOF and 3D-FIESTA sequences were evaluated. Results In 76 patients, the preoperative 3D-TOF+ 3D-FIESTA sequences diagnosed 63 patients with offending vascular compression. The coincidence rate with the surgery confirmation was 83% and 13 patients (17%) were missed diagnosis; 3D-TOF+ FIESTA+ MRVE sequences diagnosed 72 patients with offending vascular compression, the coincidence rate was 95%, and 4 were missed diagnosis (5%), P=0.04. The patients of diagnostic coincidence of the 2 kinds of sequences were mainly the arteries as offending vessels. The patients of missed diagnosis were mainly in patients with offending vessels as veins, one of the patients with subarachnoid adhesions and thickening was missed diagnosis. Conclusion MRVE technique combined with 3D-TOF and 3D-FIESTA sequences may clearly reveal the relationship of three-dimensional space between offending vessels and nerves, and improve the accurate rate for identification of offending vessels. Key words: Trigeminal neuralgia; Magnetic resonance imaging; Microvascular decompression surgery; Magnetic resonance virtual endoscopy