AIM: To evaluate the availability and our experience of intraoperative image-guidance in endoscopic nasocular operation. METHODS: Seven cases of endoscopic nasal surgery with intraoperative image-guidance were retropectively reviewed, including 3 cases of optic nerve injury; 3 cases of foreign object of optic behind the eyeball; 1 case of retrobulbar tumor (angeioma). RESULTS: The preoperative preparatory time would take 15 minutes, including coordination, head holder localization, conventional instrument registration. In our cases, the localization accuracy between 3-D image landmarks of navigation system and actual anatomical landmarks was less than 1.3mm. The optic nerve and other anatomical points could be orientated accurately in intraoperative procedures. No complication occurred. CONCLUSION: Nasal endoscope combined with image- guidance systems provides accurate anatomical localization of anterior skull base with enlarged operation field. It is possible for surgeons to observe important anatomical structures during endoscopic surgery. It could increase the effectiveness and decrease surgical complications, especially in complicated cases.