Objective: To retrospectively analyze and explore the indications, methods and prognosis of optic nerve decompression (OND) in endoscopic surgery for benign fibro-osseous lesions (FOLs) of the nasal and skull base. Methods: Among 217 cases of craniofacial fibro-osseous lesions from July 2008 to January 2025 who were treated in the Otolaryngology Head and Neck Surgery Department of Beijing Tongren Hospital Affiliated to Capital Medical University, 14 patients (6.45%, 14/217) who underwent endoscopic resection of the lesion and OND under image navigation were included in this study, including 8 males and 6 females, aged from 4 to 28 years old. Among the 14 patients, 8 had fibrous dysplasia, 5 had ossifying fibroma, and 1 had osteoma. Clinical data, imaging data, surgical data and follow-up results were collected. Best corrected visual acuity (BCVA) and other indicators before and after treatment were recorded for analysis. Statistical analysis was conducted using SPSS 26.0 software. Results: Among 14 patients, preoperative visual decline involved 17 eyes (all 8 fibrous dysplasia cases, 2/5 ossifying fibroma cases, and 1 osteoma case). Surgical approaches included: partial resection for fibrous dysplasia (8 cases; bilateral decompression in 5, unilateral in 3); total resection for ossifying fibroma (3 cases; bilateral decompression in 2, unilateral in 1) or partial resection with bilateral decompression (2 cases, including 1 aneurysmal bone cyst); and total resection with unilateral decompression for osteoma (1 case). After the operation, the vision of 10 eyes (58.82%, 10/17) had been improved. Among the 5 eyes with severe visual impairment before the operation (no light perception/light perception/exponential vision), 2 eyes improved (1 eye from no light perception to light perception, and 1 eye from visual perception to exponential vision). Eight cases (10 eyes) of patients with proptosis improved after the operation. The proptosis before and after the operation were (16.60±1.71) mm and (13.60±1.35) mm (P<0.05). Conclusions: For patients with benign FOLs involving the optic canal at the nasal and skull base who have visual impairment, OND via endoscopic endonasal approach can achieve visual salvage effects. Those with better preoperative residual vision have significant improvement in BCVA, so the operation should be performed as early as possible.