Abstract: Objective To evaluate the effect of fully neuroendoscopic microvascular decompression(MVD) versus microscopical MVD in the treatment of primary trigeminal neuralgia(PTN).Methods Patients with PTN who were admitted to Department of Neurosurgery, the Affiliated Hospital of Xuzhou Medical University from August 2018 to December 2021 and underwent MVD were selected. According to the including and excluding criteria, 112 patients were finally enrolled and their clinical data were retrospectively analyzed. They were divided into two groups: an endoscopic group(n=38) and a microscope group(n=74). Both groups were compared for postoperative effectiveness, duration of surgery, detection rate of the responsible vessels, the length of hospitalization stay, recurrence rate and the incidence of postoperative complications.Results The endoscopic group showed a postoperative cure rate of 94.74%(36/38), which was statistically different from that in the microscope group(66.22%, 49/74). There were statistical differences in the recurrence rate, the detection rate of responsible vessels, and the length of postoperative hospitalization stay between the two groups(P<0.05). Meanwhile, no statistical difference was found in the average duration of surgery between the two groups(P>0.05). The endoscopic group presented a postoperative complication rate of 10.5%, which was statistically different from that in the microscope group(29.7%).Conclusions Compared with microscopical MVD, the use of fully neuroendoscopic MVD in the treatment of PTN has a higher detection rate of responsible vessels, and showed better postoperative effectiveness and fewer complications, with a lower recurrence rate, and shorten the length of postoperative hospitalization stay.