Abstract： Microvascular decompression (MVD) is the preferred treatment for primary trigeminal neuralgia (TN). In the past, there was a visual blind spot in MVD under the microscope, and there were cases of missing responsible blood vessels after surgery. However, performing MVD under endoscopy has advantages such as good deep lighting, close observation, local magnification, no omission of responsible blood vessels, high imaging resolution, and panoramic observation. This article reports a case of primary TN on the right side. After treatment with endoscopic MVD, the pain was completely relieved and the treatment effect was satisfactory.