immediate 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 present
study. 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 any
significant morbidity on conservative management. Monitoring of brainstem auditory evoked potential in
endoscopic vascular decompression could be useful in preserving hearing. Coupling endoscope with this monitoring is especially useful in difficult
cases 21 to prevent hearing loss. Good results in the present study could be contributed to
using of an endoscope, and due to experienced endoscopic neurosurgeon
performing over 95% surgeries. 
Utilization of proper microsurgical technique such as stabilizing hand
during surgery and use of pen type of hand grip 40, 41 helps in
preventing complications and improves results. Although we used interposition technique with good results, the
transposition technique was found to be safe and effective 19 which can prevent granuloma formation and
adhesion. Interposition material, when used, should be placed in subarachnoid
space and the material should not be in contact with dura or tentorium to avoid
granuloma or adhesion formation which can result in recurrence.

vascular decompression is an effective and safe alternative 39 to
endoscopic assisted microvascular decompression in trigeminal neuralgia. The
endoscope is a useful tool in confirming vascular conflict identified by the
microscope, finding additional conflicts missed by the microscope and in
verifying the adequacy of nerve decompression. 6 Endoscopic
assistance is very effective and helpful to identify the site of compression
and to confirm the position 32 of interposition material in MVD.  Endoscopic vascular decompression offers superb visualization. 5, 10 Use of endoscope
in vascular decompression for trigeminal neuralgia allows panoramic views in
addition to good visualization of the neurovascular contact which may be missed
by microscope. 26 An endoscope is a valuable tool, especially when
the bony ridge is hiding the direct view. 30 An angled endoscope is
better for diagnosis of the offending vessel at the root entry zone. 34 The endoscope is
helpful in detecting the responsible blood vessel without retracting brain
tissue and nerve. 10, 22 In spite of all above advantages, a steep
learning curve is a limitation of the procedure.  

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Conclusion: Endoscopic vascular decompression is a safe and effective
alternative technique for trigeminal neuralgia. It is helpful in identification
of all offending vessels including double vessel. Anterior compression can be
easily identified which could be missed by microscope. It provides the
panoramic view, improved visualization without brain and nerve retraction. It helps in better identification of completeness
of decompression.