Objective To analyze the application of bilateral endonasal neuroendoscopic approach to skull base surgery.MethodsClinical data of 70 patients undergoing skull base surgery via bilateral endonasal neuroendoscopic approach was analyzed retrospectively. The clinical superiorities and application of this approach was summarized. This approach was adopted in the surgical treatment for pituitary adenoma (n=40), suprasellar meningioma (n=11), meningioma of olfactory sulcus (n=3), notochordoma (n=3), cerebrospinal rhinorrhea (n=3) , traumatic ophthalmic neuropathy (n=3), Rathke’s tumor(n=2), malformations of odontoid process (n=2) , intraorbital cavernous hemangioma (n=1), epidermoid cyst (n=1) and nasopharyngeal carcinoma (n=1).ResultsOf all the 70 cases, tumors of various kinds were confirmed in 62 cases with total removal in 54 (87.1%) and subtotal removal in 8(12.9%). Cerebrospinal fluid rhinorrhea were completely cured in all the 3 cases. The visual ability got improved after decompression of optic canal in 3 cases. The neurological symptoms were relieved significantly in the 2 patients by odontoidectomy.ConclusionsBilateral endonasal neuroendoscopic approach can fully expose skull base structures, effectively overcome the inconveniences induced by limited operation space. Through careful evaluation, proper strategy and suitable surgical approach，the highlights of therapeutic efficacy in skull base surgery can be shown.