Bothimmediate post-op and long-term outcome was good (complete, or satisfactory relief of pain was reported in over 94% and 89% patients respectively)in the present study. EVD was also found to be a safe procedure in the presentstudy. Re-surgery if needed was also safe and effective. Although we had some temporary trigeminal dysesthesia,facial paresis, CSF leak, vertigo and decreased hearing, most of them improved without anysignificant morbidity on conservative management. Monitoring of brainstem auditory evoked potential inendoscopic vascular decompression could be useful in preserving hearing. Coupling endoscope with this monitoring is especially useful in difficultcases 21 to prevent hearing loss. Good results in the present study could be contributed tousing of an endoscope, and due to experienced endoscopic neurosurgeonperforming over 95% surgeries. Utilization of proper microsurgical technique such as stabilizing handduring surgery and use of pen type of hand grip 40, 41 helps inpreventing complications and improves results.

Although we used interposition technique with good results, thetransposition technique was found to be safe and effective 19 which can prevent granuloma formation andadhesion. Interposition material, when used, should be placed in subarachnoidspace and the material should not be in contact with dura or tentorium to avoidgranuloma or adhesion formation which can result in recurrence.Endoscopicvascular decompression is an effective and safe alternative 39 toendoscopic assisted microvascular decompression in trigeminal neuralgia. Theendoscope is a useful tool in confirming vascular conflict identified by themicroscope, finding additional conflicts missed by the microscope and inverifying the adequacy of nerve decompression.

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6 Endoscopicassistance is very effective and helpful to identify the site of compressionand to confirm the position 32 of interposition material in MVD.  Endoscopic vascular decompression offers superb visualization. 5, 10 Use of endoscopein vascular decompression for trigeminal neuralgia allows panoramic views inaddition to good visualization of the neurovascular contact which may be missedby microscope.

26 An endoscope is a valuable tool, especially whenthe bony ridge is hiding the direct view. 30 An angled endoscope isbetter for diagnosis of the offending vessel at the root entry zone. 34 The endoscope ishelpful in detecting the responsible blood vessel without retracting braintissue and nerve.

10, 22 In spite of all above advantages, a steeplearning curve is a limitation of the procedure.  Conclusion: Endoscopic vascular decompression is a safe and effectivealternative technique for trigeminal neuralgia. It is helpful in identificationof all offending vessels including double vessel. Anterior compression can beeasily identified which could be missed by microscope.

It provides thepanoramic view, improved visualization without brain and nerve retraction. It helps in better identification of completenessof decompression.