Endoscopic procedures are increasingly used in spine and brain surgeries in recent time such as brain abscess, hydrocephalus, arachnoid cyst, hematoma, 44 tuberculous meningitis with hydrocephalus, pituitary surgery, cranio-vertebral region lesions, 36, 43 lumbar spines, colloid cyst, cervical spine, 42 craniopharyngioma, 37 deep-seated brain tumors, 29 CSF Rhinorrhea, spine tumors, 25 and in Arnold Chiari malformation 28 etc. Endoscopic vascular decompression has been reported to be a safe and efficient method in present study, similar results were reported by other authors. 20, 31, 38 Offending vessels were found in the majority of cases in present series. Preoperative imaging 9, 12 and intraoperative Indocyanine Green angiography 35 could be useful to detect offending vessel. Although we did not use intraoperative Indocyanine Green angiography. Although knowledge about the site of the offending vessel with the help of preoperative MRI could be useful in reducing dissection, culprit vessels are usually seen medial to TN for neuralgia due to second division whereas it is on the lateral side for third division neuralgia. 45
Although single vessel compression was observed in the majority of cases, double vessels were also seen in 23% cases. This stress the need for the thorough search of an additional vessel to reduce recurrence. Anterior compression was observed in about 17% patients in the present study. Such lesions are difficult to be visualized with the help of a microscope. Endoscope being a better visualizing tool allows identification of such vascular lesions hidden anterior to the trigeminal nerve without retraction of brain and nerve. Although prominent suprameatal tubercle was observed in 6 patients, entire nerve from the pons to the ganglion could be visualized very well without any brain retraction or additional bony drilling. This was possible with the help of endoscope which may not be possible with the help of microscope without bone drilling or excessive brain retraction. The average duration of surgery was comparable to microscopic technique. Whole surgery can be done with the help of an endoscope, which helps in avoiding time wastage in changing from microscope to endoscope and back to microscope.