Objective To compare the effect of continue profound neuromuscular blockade and non‑continue deep neuromuscular blockade on intracranial pressure [indicated by optic nerve sheath diameter (ONSD) measured by ultrasound] during steep Trendelenburg position in patients undergoing robot‑assisted laparoscopic gynecological surgery. Methods It was a single‑center randomized, double‑blind clinical trial. Inclusion criteria were age between 18 y and 80 y, American Society of Anesthesiologists status of Ⅰ and Ⅱ, and body mass index between 18 kg/m2 and 30 kg/m2. Fifty patients were assigned to continue profound neuromuscular blockade group and non‑continue deep neuromuscular blockade group according to the random sequence table generated by computer, 25 cases in each group, titrating rocuronium dose to post‑tetanic count of 1‒2 and giving only induction dose during surgery, respectively. Sugammadex was given for neuromuscular blockade reversal at the end of the surgery. The primary endpoint was ONSD at the end of steep Trendelenburg position. Secondary endpoints included the recovery time, extubation time, the times of pneumoperitoneum pressure increase requested by surgeons, the incidence of restness and hypoxia during recovery period, the incidence of shoulder pain within 24 h after operation, and patient satisfaction score by 24 h after surgery. Results There was no significant difference in ONSD before steep Trendelenburg position between the two groups (P>0.05), and the ONSD of the continue profound neuromuscular blockade group at the end of steep Trendelenburg position was significantly smaller than that of the non‑continue deep neuromuscular blockade group (P<0.05). Compared with the baseline value before steep Trendelenburg position, the ONSD of patients in the non‑continue deep neuromuscular blockade group was significantly increased after the end of steep Trendelenburg position (P<0.05), and there was no significant difference in ONSD of patients in the continue profound neuromuscular blockade group (P>0.05). There were no significant differences in recovery time, extubation time, times of up‑regulation of abdominal pressure, incidence of adverse events such as agitation and hypoxia during recovery period, and satisfaction score of patients 24 h after operation between the two groups (P>0.05). The incidence of shoulder pain in the continue profound neuromuscular blockade group was lower than that in the non‑continue deep neuromuscular blockade group (P<0.05). Conclusion Deep neuromuscular blockade may benefit patients of steep Trendelenburg position during robot‑assisted laparoscopic gynecological surgery by alleviating the increase of intracranial pressure.