Background: Trigeminal neuralgia (TN) presents a significant challenge for athletes, where neuropathic pain can severely impact performance and quality of life. Microvascular decompression offers a potential cure, and novel surgical approaches such as the petrosal and cerebellopontine fissure methods have shown promising results. However, their effectiveness specifically in athletes requires further evaluation. Objective: This study aims to assess the effectiveness of the petrosal and cerebellopontine fissure approaches in complex microvascular decompression of TN in athletes, focusing on surgical outcomes and recovery quality. Methods: From August 2020 to August 2022, 90 athletes diagnosed with TN were randomized into two groups: a control group (n = 45) treated via the conventional bone flap approach and an observation group (n = 45) undergoing surgery through the cerebellar petrosal and venous space approaches. Metrics compared included operation time, hospital stay, intraoperative blood loss, preoperative and postoperative pain levels, sleep quality, pain-associated factors, serum inflammatory markers, and postoperative complications. Results: The observation group showed a significantly higher treatment efficacy rate of 95.56% compared to 84.44% in the control group. Notably, the observation group experienced shorter operation times, less intraoperative bleeding, fewer surgical adjustments, and a lower incidence of cerebellar contusions (all P < 0.05). Improvements in digital pain scale (NRS) and Pittsburgh Sleep Quality Index (PSQI) scores were more pronounced in the observation group at intervals post-surgery (P < 0.05). Additionally, reductions in inflammatory markers such as IL-6, hs-CRP, and TNF-α were significantly greater in the observation group, aligning with lower postoperative complication rates of 4.44% compared to 17.78% in the control group (P < 0.05). Conclusion: The petrosal and cerebellopontine fissure approaches in microvascular decompression for TN are particularly beneficial for athletes, offering superior outcomes with reduced surgical impact and enhanced recovery. These techniques not only mitigate the immediate surgical risks but also support quicker resumption of training and competition by effectively managing pain and minimizing inflammatory responses post-surgery. This study advocates for a tailored surgical approach that considers the unique needs of athletes facing neuropathic conditions like TN.