Abstract Objective:To compare the efficacy and prognosis of traumatic optic neuropathy (TON) treated with craniotomy and endoscopic transethmosphenoid optic canal decompression (ETOCD). Methods:A retrospective analysis of the diagnosis and treatment of 54 TON patients from January 1,2017 to December 31,2020 in the Department of Neurosurgery of the First Affiliated Hospital of Nanjing Medical University, the statistical difference of curative effect between two surgical approaches were compared. Results: Regardless of surgical approach, treatment within 3days after trauma significantly improved patients’ eyesight compared to 4-7days after trauma. However, there were no differences between mean surgery duration and outcomes obtained at the same period. Craniotomy group has longer hospitalization time than transethmosphenoid group. A total of 9 patients developed postoperative complications, including intracranial infection and cerebrospinal fluid leakage.Among them, 7 cases occurred in craniotomy group, which was higher than that in transethmosphenoid group. After 3-6months follow-up, eyesight was improved in 40 patients, including 19 patients in craniotomy group and 21 patients intransethmosphenoid group. No difference was found between the two groups during follow-up. Conclusions: Surgery improve eyesight in TON patients, whether craniotomy and ETOCD have no significant difference in degree of eyesight recovery. However, ETOCD has the advantages of less injury, less complications and shorter hospitalization time, which is worthy of popularization and application.