Aim: was to compare and evaluate microscopic vascular decompression and endoscopic vascular decompression for trigeminal neuralgia. Setting and Design: It is an observational study Materials and Methods: The present study was conducted in Department of Neurosurgery at SMS Medical College during November 2017-December 2019 among the patients with the diagnosis of medically refractory trigeminal neuralgia. Thirty three patients were recruited for the study, out of which 22 and 11 underwent MVD and EMVD respectively. Before the surgery parameters like age, gender, chief complaints, duration of symptom, side and number of involved branches were recorded. Patients with trigeminal neuralgia were managed by surgical exploration using a standard retrosigmoid approach. Patients were followed up at one and three months post-surgery. Outcomes were categorized into four groups: excellent, good, fair, and poor. Various complications and relive of symptoms were also recorded. Statistics: Difference between two groups was determined using chi square test and the level of significance was set at p < 0.05. Results: Excellent outcome was reported among 81.82% of the subjects in EMVD while it was found only in 59.09% of the subjects in MVD group. Poor outcome was revealed only in 4.55% of the subjects in MVD group with statistically insignificant difference. Conclusion: It can be concluded from the results of present study that endoscopic microvascular decompression is a safe, feasible and effective procedure for cure of trigeminal neuralgia.