Background <p>Endoscopic vidian neurectomy has been performed for decades on patients with refractory allergic rhinitis and vasomotor rhinitis. Although the surgical approach has evolved continuously, it still has deficiencies in terms of accuracy and safety. To overcome these deficiencies, we conducted anatomical study to propose a modified endoscopic vidian neurectomy.</p> Methods <p>Five adult dry skulls and seven fresh skull specimens were used to identify landmarks for locating the vidian nerve. The modified surgical approach was applied to 9 patients with allergic or vasomotor rhinitis to test its feasibility and safety.</p> Results <p>We confirmed and successfully applied the sphenoidal process of the palatine bone, the medial pterygoid plate, and the bony crest extending from the root of the pterygoid process of the sphenoid bone as landmarks in our modified endoscopic vidian neurectomy.</p> Conclusion <p>This study describes a modified surgical approach for endoscopic vidian neurectomy that improves the accuracy and safety of the procedure by locating the vidian nerve without opening the sinuses or exposing the sphenopalatine foramen.</p>