Microvascular decompression (MVD) is a highly accepted and effective method for treatment of patients with primary trigeminal neuralgia (TN) result from vascular compression. However, endoscopic neurovascular decompression (ENVD) for TN provides the better surgical outcomes and minimal complication and recurrence rates and good levels of patient contentment over the long run. AIM OF THE WORK: To evaluate the effect of endoscopic neurovascular decompression (ENVD) for management of trigeminal neuralgia. PATIENTS AND METHODS: A retrospective, noncomparative, consecutive case series of 12 cases (8 male/ 4 female) Primary TN cases (mean age 57.5 years; range, 43-61) experienced endoscopic retrosigmoid approach for neurovascular decompression [NVD] in neurosurgical wards. Carried out between January 2018 and January 2020 at Al-Azhar University Hospitals. Trigeminal neuralgia was diagnosed after a thorough history, targeted physical assessment, and MRI were performed to rule out other cerebellopontine (CPA) cranial neuropathies, MRI was done on all patients using T1 and T2 scans without contrast and a T1 sequence with contrast Results: Improvement of trigeminal pain was noticed in all cases subjected to endoscopic surgery in this research within 24 h after surgery after full recovery. Abortion of producer occur early in one patient due to intraoperative bleeding from laceration of bridging veins during cerebellar retraction and bleeding stopped by compression. patient had recovered safely with a good improvement of trigeminal pain but six months post operative patient complaining of facial pain and controlled by medical treatment. No cases of a cerebrospinal fluid leak or hearing impairment were recorded. No recurrence of trigeminal pain at the follow-up period ranged from 6 months to two years. Conclusions: ENVD for trigeminal nerve is minimally invasive procedure effective in release neurovascular conflicts and improving pain of trigeminal neuralgia. and safe procedure demonstrate, a minimal rate of surgical complications and a good functional outcome.