Objective To analyze the application effect of craniopharyngioma resection through nasal sphenoid sinus enlargement sellar floor approach under neuroendoscope in patients with complicated craniopharyngioma.Methods From December 2018 to December 2022， 48 patients with complex craniopharyngioma who received craniopharyngioma resection through nasal sphenoid sinus enlargement sellar floor approach under neuroendoscope of Baoding Second Central Hospital of neurosurgery were selected as the experimental group， and 48 patients with complex craniopharyngioma who received craniopharyngioma resection via nasal sphenoid sinus during the same period were selected as the control group， postoperative monitoring of the patient's water， electrolyte， central venous pressure and other indicators， timely review of pituitary hormones， according to the review of hormones to supplement the corresponding hormone.， the pituitary hormone should be rechecked in time， and the corresponding hormone should be supplemented according to the rechecked hormone situation. Clinical data of patients were collected retrospectively. The surgical situation， clinical remission rate and total tumor resection rate， pituitary function before and 1 month after surgery， inflammatory reaction and stress index before and 1 d after surgery， and complications 1 month after surgery were compared between the two groups.Results Compared with the control group， the experimental group had shorter operation time， tumor resection time and hospital stay （P<0.05）. There was no significant difference in intraoperative blood loss between the two groups （P>0.05）. The total resection rate and clinical remission rate of experimental group were 70.83%（34/48） and 85.42%（41/48）， which were higher than those of control group 43.75%（21/48） and 60.42%（29/48）， the difference was statistically significant （P<0.05）. There was no significant difference between the two groups in near-total resection， subtotal resection and majority resection （P>0.05）. Compared with before surgery， the serum levels of thyrotropin （TSH）， growth hormone （GH）， adrenocorticotropic hormone （ACTH） and total thyroxin （TT4） in the two groups decreased 1 month after surgery， and those in the experimental group were higher （P<0.05）. Compared with before surgery， whole blood level of neutrophils count to lymphocyte ratio （NLR） 1 d after surgery in the two groups increased， but lower in the experimental group （P<0.05）. Compared with before surgery， serum levels of procalcitonin （PCT）， C-reactive protein （CRP）， interleukin-6 （IL-6）， angiotensin Ⅱ （AngⅡ）， epinephrine （E） and norepinephrine （NE） in the two groups increased 1 d after surgery， but lower in the experimental group （P<0.05）. 1 month after surgery， the complication （including diabetes insipidus， hypopituitarism， cranial nerve injury， cerebrospinal fluid leakage， intracranial infection， hemiplegia， epilepsy， etc.） rate of the experimental group （16.67%） was lower than that of the control group （45.83%， P<0.05）. In the control group， there were 7 cases of recurrence， 4 cases of total resection， 2 cases of subtotal resection and 1 case of partial resection. The postoperative complications were diabetes insipidus in 3 cases and intracranial infection in 1 case. In the experimental group， there were 8 recurrent cases， 6 cases of total resection， 2 cases of subtotal resection and 0 cases of partial resection after surgical treatment. The incidence of postoperative complications was diabetes insipidus in 2 cases.Conclusion Craniopharyngioma resection through nasal sphenoid sinus enlargement sellar floor approach under neuroendoscope could improve the clinical remission rate and total tumor resection rate of complex craniopharyngioma patients， reduce inflammatory response and stress indexes， improve pituitary function and safety， the treatment effect of recurrent craniopharyngioma was also good. ［Journal of International Neurology and Neurosurgery, 2024, 51(4): 45-51］