Objective: Although most surgeons use microvascular decompression, and are using endoscope as an adjunct to microscope, full endoscopic technique, though very useful, is less commonly performed. Present study is aimed to evaluate results of 230 patients of endoscopic vascular decompression. Methods: A retrospective study was carried out in a tertiary care hospital. Patients with typical neuralgia, with or without preoperatively detected vascular compression, were advised to undergo vascular decompression. Medically unfit or frail patients, atypical neuralgia and neuralgia secondary to an aneurysm, tumors, vascular malformation etc. were excluded. Results: Age group ranged from 31 to 76 years. There were 124 female patients. Maxillary, mandibular, ophthalmic and both maxillary and mandibular division were involved in 116, 93, 1 and 20 patients respectively. Offending vessels were found in 223 patients. Superior cerebellar artery, anterior inferior cerebellar artery, tortuous basilar artery and vein as conflict was seen in 174, 96, 1 and 2 patients respectively. Single and double vessels conflict was observed in 173 and 50 patients respectively. The compressing vessel was placed anterior to the trigeminal nerve in 39 patients. An arterial loop was producing contact with nerve, grooving, and displacement in 215, 35 and 21 patients respectively. Entire nerve could be visualized well without brain retraction in all patients. The average duration of surgery and hospital stay was105 minutes and 2.6 days respectively. Complete, satisfactory and no relief of pain was detected in 204 (88.7%), 11 (5.8%) and 15 (6.5%) patients respective. Recurrence was observed in 25 patients at an average 60 months follow up. Temporary complications included trigeminal dysesthesia, vertigo, facial paresis, CSF leak, and reduced hearing in 9, 8, 8, 7, and 3 patients respectively. Conclusion: Vascular decompression using endoscope is a safe and efficient alternative technique. It is helpful in identification of all offending vessels including the double vessel, and anterior compression. It provides the panoramic view, and improved visualization without brain and nerve retraction. It assists in improved recognition of full decompression of nerve.