ObjectiveTo compare the therapeutic effect of transnasal neurosurgery for skull base chordoma with microscope vs neuroendoscope.MethodsClinical data of 56 patients suffering from skull base chordoma hospitalized in our department from Dec. 2008 to Dec. 2015 were analyzed retrospectively. Of them, 31 were male and 25 were female, with an age range from 16 to 77 years (average age 42.6 years). All the patients underwent transnasal tumor removal with with microscope (microscope group) or neuroendoscope (neuroendoscope group). The therapeutic effect and complications between the two groups were compared.ResultsOf the 38 patients in the microscope group, total tumor resection was achieved in 6, subtotal resection in 14 and partial resection in 18, with a total tumor resection rate of 15.8%. Of the 18 patients in the neuroendoscope group, the total, subtotal and partial resections were achieved in 10, 4, and 4 cases respectively, with a total resection rate of 55.6%. The difference of total tumor resection rate between the two groups was statistically significant (P<0.05). The symptom improvement in the neuroendoscope group was better than that in the microscope group, and the difference between the two groups was also statistically significant (P<0.05). The difference of complication rate between the two groups was statistically insignificant (P>0.05).ConclusionWith high total tumor resection rate and no significant increase of complication rate, transnasal neuroendoscopic approach is preferred in the surgical treatment of skull base chordoma.