Objective To investigate the clinical efficacy and safety of endoscopic highly selective vidian neurotomy in the treatment of refractory nasal mucosal hyperreactive rhinopathy. Method Patients diagnosed with refractory allergic rhinitis and vasomotor rhinitis and agreed to receive highly selective vidian neurotomy in our outpatient department from January 2019 to March 2021 were selected. All the patients received endoscopic highly selective vidian neurotomy and were followed up for one year. Symptom scores, quality-of-life scores as well as drug scores were evaluated before and 1 month, 3 months, 6 months and 12 months after surgery respectively. Meanwhile, adverse reactions were recorded. Results 35 cases had complete follow-up data, the total symptom scores, total nasal symptom scores, total eye symptom scores and total asthma symptom scores 1 month, 3 months, 6 months and 12 months after surgery were all significantly reduced compared with preoperative values (P all＜0.001). The quality-of-life scores and drug scores were significantly improved 1 month, 3 months, 6 months and 12 months after surgery compared with preoperative levels (P all＜0.001). One patient had unilateral nasal bleeding after surgery, and the other patient had transient postoperative headache, however, no patients had complications such as dry eye, ocular foreign body sensation, upper palate numbness, or atrophic rhinitis during follow-up visits. Conclusion Endoscopic highly selective vidian neurotomy, which can effectively improve the high secretion and high sensitivity state of refractory rhinitis, improve the quality of life of patients, and avoid the disadvantages of postoperative dry eyes, is an effective and safe means for the treatment of refractory nasal mucosa hyperreactive rhinopathy.