Objective To explore the method and therapeutic effect of endoscopic highly selective posterior nasal neurecotmy for the treatment of moderate-severe perennial allergic rhinitis (AR).Methods A total of 30 patients with moderate-severe PAR refractory to routine medical therapy and immunotherapy were selected as the observation group, and endoscopic bilateral highly selective posterior nasal plexus transection was performed. At the same time, 30 patients with poor curative effect were selected as the control group, and continued on their regular medicine. The main symptoms were scored by visual analogue scale (VAS), and the surgical effect was evaluated by integral method.Results All the patients were followed up for one year. Follow-up evaluation revealed that 6 cases were effective and 24 were ineffective with a total effective rate of 20.00% in the control group, and 29 cases were effective and one was ineffective with a total effective rate of 96.7% in the observation group. The difference between the two groups was statistically significant (P<0.05). The VAS scores of nasal congestion, rhinorrhea and sneezing in the observation group were lower than those in the control group (all P<0.05), and the symptoms in the observation group were relieved significantly. During the follow-up period, active epistaxis, dry eye and palate numbness occurred in none of them.Conclusions Endoscopic highly selective posterior nasal neurectomy may take effect in treating moderate-severe PAR in short time. With avoiding injury of the sphenopalatine ganglion in the complete amputation of branches of posterior nasal nerve, postoperative complications are reduced.