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Objective To explore the value of endoscope in microvascular decompression (MVD) for idiopathic trigeminal neuralgia (ITN). Methods The clinical data, operative data and follow-up results of 58 patients with ITN, who underwent endoscope-assisted MVD from March, 2010 to December, 2013 were analyzed retrospectively. The endoscope was used to distinguish the responsible vessels and confirm the location of Teflon in MVD. Results No severe complications such as intracranial hemorrhage, cerebrospinal fluid leakage and facial paralysis occurred and the responsible vessels of 54 case(93. 1%) were found in 58 ITN patients. The responsible vessels of 5 cases (8. 6% ) were missed under the microscope, but they were found by endoscope. The effective rate was 98. 3% in 58 ITN cases, with 55 cases (94. 8%) completely relief and 2 cases (3. 4%) little residual pain. 3 cases (5. 3%) recurred in 2 years after operation. Conclusions Endoscope- assisted MVD for ITN has contributed to judge responsible vessels and place telflon correctly. It can improve the surgical curative effects and reduce postoperative complications. [ABSTRACT FROM AUTHOR]