To evaluate the advantages and disadvantages of different type of image-guidance system in endoscopic sinus surgery.Fifty-three endoscopic sinus surgery were performed under different type of image-guidance system, there were 24 chronic sinusitis with or without nasal polyp, 4 juvenile nasopharyngeal angiofibroma, 8 pituitary adenoma, 9 ethmoid ossifying fibroma, 2 nasopharyngeal mixed tumor, 1 nasal leiomyoma, 3 fungal sinusitis, and 2 inverting papilloma.In all cases, the preoperative time was 15-30 minutes, the registration rate were 1.3-2.0, the localization accuracy was within 1 mm. Compared with the traditional endoscopic sinus surgery, the operating time was similar, without obvious difference. No complication occurred.All types of image-guidance system could work well with endoscopic system, each of them had its own shortages. Every type of image-guidance system could identify the borders and critical anatomical structures in the corresponding CT data, especially in cases in which anatomical landmarks were no longer present, with anatomical variation, intranasal and anterior skull base tumor. Combined with endoscopic surgery, the image-guided endoscopic surgery provided accurate tumor resection while preserving normal tissue, increased surgical effectiveness, decreased overall surgical complications. It is believed that the image-guidance system is a useful tool for endoscopic sinus surgery.