Abstract： Objective:To study the efficacy of neuroendoscopy-assisted transnasal transsphenoidal expanded approach for craniopharyngioma resection in treating craniopharyngioma and its impact on stress response and inflammatory levels.Methods:A total of 92 patients with craniopharyngioma admitted to the Neurosurgery Department of Baoding Second Central Hospital from November 2020 to November 2022 were selected as the study objects. The patients were divided into the study group (46 cases) and the control group (46 cases) by a central randomized system. The control group was treated with craniotomy approach, and the study group was treated with expanded transnasal transsphenoidal approach under neuroendoscopy. The operation conditions (including operation duration, blood loss and hospital stay, etc.), stress response indexes, inflammation level, tumor resection and postoperative complications of the two groups were analyzed.Results:There was no significant difference in operation duration and blood loss between the study group and the control group (P>0.05). However, the hospitalization time of the study group was less than that of the control group (P<0.05). The total resection rate (47.83%) and the remission rate of clinical symptoms after 3 months of follow-up (86.96%) of the study group were higher than those of the control group (34.78%, 47.83%) (P<0.05). The postoperative levels of epinephrine, norepinephrine, cortisol, C-reactive protein, interleukin-1β, monocyte chemotactic protein, interleukin-8 and tumor necrosis factor-α in the study group were lower than those before surgery, and lower than those in the control group (P<0.05). The complication rate of the study group (13.04%) was lower than that of the control group (30.43%, P<0.05).Conclusion:Compared with the traditional craniotomy, the craniopharyngioma resection through transnasal endoscopic expanded sellar approach under neuroendoscope can increase the total resection rate of the tumor, improve the surgical outcome, reduce the level of stress response and inflammation, and reduce the incidence of complications.