Abstract： Objective To explore the clinical effect and safety of endoscopic surgery for craniopharyngioma through na-sal transsphenoidal approach.Methods 76 patients with craniopharyngioma were selected and randomly divided into the treat-ment group and the control group,with 38 patients in each group.The treatment group underwent endoscopic surgery through the nasal transsphenoidal approach,while the control group underwent surgery through the cranial approach.Compared the surgical in-dicators,clinical efficacy,and incidence of complications between the 2 groups.Results Intraoperative bleeding in the treatment group was less than that in the control group,and the surgical time,tumor resection time,and hospitalization time were shorter than those in the control group,with statistical differences(P＜0.05).The total effective rate of the treatment group was 97.37％(37/38),which was higher than 78.95％(30/38)of the control group,with a statistical difference(P＜0.05);The total incidence of complications in the treatment group was 2.63％(1/38),lower than the control group,23.68％(9/38),with a statistical differ-ence(P＜0.05).Conclusion Neuroendoscopic transnasal transsphenoidal surgery for craniopharyngioma can improve the thera-peutic effect,shorten the surgical time,reduce bleeding and complications,and accelerate the patient's recovery speed,which is safe and effective.