To evaluate the advantages of image-guidance system in endoscopic sinus surgery.Twenty-eight endoscopic sinus surgery procedures were performed with the help of image-guidance system. There were 11 cases of chronic sinusitis with/or without nasal polyps, 4 juvenile nasopharyngeal angiofibromas, 6 pituitary adenomas, 3 ethmoid ossifying fibromas, 2 nasopharyngeal mixed tumors, 1 nasal leiomyoma, 1 fungal sinusitis, and 1 inverted papilloma.In all cases, the preoperative operation would take 15-30 minutes, the registration rate was 1.3-2.0, the localization accuracy was within 1 mm. Compared with the traditional endoscopic sinus surgery, the operative time did not differ obviously. No complication occurred.The image-guidance system could identify the operative borders and critical anatomical structures together with the corresponding CT data, especially in cases with anatomical variations, unidentified anatomical landmarks, and intranasal or anterior skull base tumors. Endoscopic sinus surgery, combined with the image-guidance system, provided accurate tumor resection while preserving normal tissue. It could increase surgical effectiveness and decrease overall surgical complications. We believe that the image-guidance system is a useful tool for endoscopic sinus surgery.