Pseudotumor cerebri (idiopathic intracranial hypertension) is a syndrome characterized by intracranial pressure elevation and associated signs and symptoms in the absence of a space-occupying intracranial lesion. The most common symptoms are visual loss and headache. Sometimes, surgical therapy is needed in patients who have no apparent response to medical therapy and exhibit a progressive course. Optic nerve decompression is an effective and recommended treatment approach for patients with pseudotumor cerebri in whom visual loss predominates. With the growing experience with endoscopic skull base approaches, this method has begun to be used as an alternative and effective treatment modality. In this study, we aimed to present the outcome of endoscopic endonasal optic nerve decompression and to review the literature on this treatment modality in 2 patients diagnosed with pseudotumor cerebri that was unresponsive to medical therapy and associated with progressive visual loss.