To establish the types of endoscopic endonasal nasopharyngectomy for nasopharyngeal carcinoma (NPC) based on anatomic study and clinical applications.

Dissection of the skull base using an endoscopic endonasal approach was performed on a cadaver head. The procedures of endoscopic endonasal nasopharyngectomy for recurrent NPC (rNPC) were used and established.

The procedures of endoscopic endonasal nasopharyngectomy for rNPC were grouped into 4 types: type Ⅰ was used for rT₁ and rT₃ rNPC located in the midline of the nasopharynx and skull base: type Ⅱ was used for rT₂ rNPC with involvement of the cartilaginous Eustachian tube, medial petroclival region, and parapharyngeal space: type Ⅲ was used for rT₄ rNPC extending further laterally into the lateral petroclival region, infratemporal fossa, middle of the skull base, superior orbital fissure, cavernous sinus, and cranial nerves: and type Ⅳ was used for rNPC invading the internal carotid artery (ICA) and middle cranial fossa.

The 4 types of endoscopic endonasal nasopharyngectomy are effective for the surgical treatment of rNPC. Pre-operation evaluation and staged exposure of the ICA is reliable, which will be an effective guideline for surgical treatment of rNPC.