Objective To compare the effect of neuroendoscopically assisted and microscopic vascular decompression in patients with hemifacial spasm.Methods The clinical data of 80 patients with facial spasm admitted to our hospital from January 2020 to January 2022 were analyzed retrospectively. Among them， 40 patients were treated with microscopic vascular decompression （group A）， and the remaining 40 patients were treated with microscopic vascular decompression assisted by neuroendoscope （group B）. The operation， intensity of facial spasm before and after treatment， clinical efficacy and postoperative complications were compared between the two groups.Results The proportion of subdural operation time<30 minutes in Group B was higher than that in Group A， and the difference was statistically significant （P<0.05）. There was no statistically significant difference in the intensity of hemifacial spasm in group A before treatment （P>0.05）， and the intensity of hemifacial spasm in group A after treatment was improved compared with that in the two groups before treatment， but there was no statistically significant difference between the two groups （P > 0.05）. The total clinical effective rate of group A and B was 95.00% and 92.50%， respectively， and the difference was not significant （P>0.05）. The total incidence of postoperative complications in group A and group B was 2.50% and 5.00%， respectively， with no significant difference （P>0.05）.Conclusion Neuroendoscopic assisted microvascular decompression can shorten the dural operation time in patients with facial spasm， and has certain clinical application value.