The rigid nasal endoscope was used through a transseptal approach to reach the sphenopalatine foramen and to ligate its artery in 9 patients with intractable posterior epistaxis. Immediate and complete cessation of the bleeding uniformly occurred, except in 1 case, in which there was persistent bleeding on endoscopic examination of the nasal cavity at the end of the procedure. The ligature was checked and the artery was reclipped. Thereafter, the patient's recovery was uncomplicated and free of further epistaxis. Endoscopic transseptal sphenopalatine artery ligation offers a reliable option in the treatment of intractable posterior epistaxis. The submucoperiosteal dissection reduces bleeding, shortens operation time, and allows relatively easy identification of the sphenopalatine foramen. The procedure allows direct positive control of the major vessel supplying the posterior nasal cavity. It avoids the complications associated with transantral and pterygopalatine fossa surgery.