AIM: To evaluate the effects of propofol and desflurane on intracranial pressure in  patients undergoing gynecological laparoscopic surgery by measuring the ratio of optic nerve sheath diameter (ONSD) to transverse diameter of the eye (ETD).  METHODS: Forty patients, scheduled for elective gynecological endoscopic surgery, were randomly divided into propofol group (group P) and desflurane group (group D) (n=20). Anesthesia maintenance: propofol was injected intravenously in group P, desflurane was inhaled in group D. Remifentanil was injected intravenously and rocuronium was added on schedule. The patients were mechanically ventilated in volume-controlled mode. ETD was recorded after induction of anesthesia. ONSD, HR, MAP, peak airway pressure (Ppeak) and PETCO2 were recorded 5 min after induction of anesthesia (T0), 10 min (T1), 30 min (T2), 60 min (T3) after Trendelenburg position and after resuming the supine position (T4). ONSD/ETD values were calculated at different time points. RESULTS: Compared with T0, ONSD values of the two groups were increased at T2-T3 (P<0.05). ONSD value of group D was higher than that of group P at T2 (P<0.05). Compared with T0, the ratio of ONSD/ETD in group D was significantly increased at T1 (P<0.05). The ratio of ONSD/ETD in group D was significantly higher than that in group P at T1-T4 (P<0.05). Compared with T0, MAP in both groups was significantly increased at T1-T4 (P<0.05); Ppeak in both groups increased significantly at T1-T3 (P<0.05). MAP in group D was significantly lower than that in group P at T2-T3 (P<0.05). There was no significant difference in the incidence of postoperative adverse reactions between the two groups. CONCLUSION: In addition to remifentanil as anesthesia maintenance analgesic, intravenous injection of propofol or inhalation of desflurane can be safely used in gynecological laparoscopic anesthesia maintenance. Compared with desflurane, propofol maintenance can relieve the increase of intracranial pressure.