Olfactory neuroblastoma arises from the olfactory epithelium at the top of the nasal cavity, in the area of the sieve recess of the anterior skull base. Because of its location, it mostly occurs with skull base invasion, destruction of skull base bone, and skull base invasion. Its early symptoms include loss of smell, nasal congestion, dyspnea, and nose bleeding. Surgical treatment is preferred. We saw a patient from Jiangsu, female, 56 years old, who had intermittent nasal bleeding and hyposmia for 3 months. After coming to the clinic, we examined, and found, a large tumor in the anterior skull base region of the nasal cavity with significant enhancement (meaning rich blood supply); and bone destruction in the skull base region. But more fortunately, on the imaging, it showed no tumor invasion in the intracranial dura. For this type of tumor, resection of the tumor as well as the olfactory epithelium of the skull base and the bone of the sieve notch was required, and only then could all the tiny cancer nests in the sieve foramen be ensured to be removed. After careful planning, a transnasal endoscopic resection of the tumor, the olfactory region and the bones of the skull base (corpus cavernosum, sieve plate and sieve recess) was performed through the natural nostril, followed by skull base reconstruction. The tumor was completely removed. MRI images were reviewed after surgery. During the surgery, the anterior skull base dura was exposed after total tumor resection. The patient was discharged one week after surgery. Currently under observation.