Abstract: ob＜x＞jective To discuss the effect of microvascular decompression under neuroendoscope in the treatment of hemifacial spasm, the occurrence of facial and auditory nerve complications. Methods From January 2017 to March 2019, 60 patients with primary facial spasm diagnosed by facial nerve MRI were selected and analyzed. They were randomly divided into two groups, 30 cases in each group. The control group was treated by microvascular decompression under a simple microscope, and the observation group was treated by microvascular decompression assisted by neuroendoscopy. The clinical effect, quality of life, recurrence and complications of the two groups were compared. Results After treatment, the total clinical effective rate of the observation group was significantly higher than that of the control group (P<0.05). The scores of HFS-8 of the two groups were lower than those before treatment (P<0.05), and the scores of HFS-8 of the observation group were significantly lower than those of the control group (P<0.05). The Incidence of complications in the observation group was significantly lower than that in the control group (P<0.05). Conclusion Endoscopic microvascular decompression is more effective in the treatment of hemifacial spasm.It can find the responsible vessels in the dorsal side of facial nerve that cannot be observed under the microscope,and reduce the omission and misjudgment of responsible vessels.Patients have a higher quality of life,fewer complications and a lower recurrence rate. Neuroendoscopic microvascular decompression has obvious clinical advantages over microscopic microvascular decompression alone.