In the 1980s and 1990s, several authors suggested an endoscopic approach to the cerebellopotine angle, but it is only more recently that the technical and operative conditions for successful endoscopy could be met. The retrosigmoid approach provides simple and direct access to the cerebellopontine zone. The endoscope, owing to distal light and panoramic view, provides excellent illumination of a wide visual field within this anatomic site particularly rich in neurovascular structures. The endoscope expands the view inside the cerebellopontine angle without touching the cerebellum or the brainstem and allows clear identification of the vascular and nervous components crossing the cerebellopontine angle. The addition of endoscopic techniques during microvascular decompression surgery is a key point to ensure a safe way to recognize the offending vessels.