Objective:To explore the clinical efficacy of removal of large and medium-sized meningiomas in the sellar region via neuroendoscope assisted supraorbital keyhole approach.Methods:The clinical data of 13 patients with large and medium-sized meningiomas in the sellar region accepted surgery via neuroendoscope assisted supraorbital keyhole approach in our hospital from March 2017 to March 2019 were analyzed retrospectively. The surgical efficacies of these patients were analyzed.Results:Total removal was achieved in all 13 patients: 2 were with Simpson I resection, and 11 with Simpson II resection. The vision was improved in all patients. After surgery, scalp hydrops appeared in 2 patients, transient diabetes insipidus in 2 patients, and recurrent hyponatremia and hypokalemia in one patient; these symptoms were relieved gradually for 2 weeks. No olfactory disturbance was noted in these 13 patients. Follow up for 3-18 months showed no recurrence, and Karnofsky performance status scores were≥80.Conclusion:Surgery via supraorbital keyhole approach is suitable for large and medium sized meningiomas in the sellar region, with advantages of beauty, minimal invasion, few postoperative complications and quick recovery.