Enhancing　nitrogen　removal　is　a　very　active　branch　in　municipal　wastewater　treatment　research,　toward　this　end,　anammox　technology　is　a　sustainable　solution.　This　review　systematically　outlines　the　strategies　employed　to　enhance　mainstream　anammox　performance,　including　nitrite　accumulation　and　microbial　enrichment　based　on　partial　nitrification　coupled　anammox　and　partial　denitrification　coupled　anammox,　developed　to　address　the　challenges　of　low　ammonium　content　in　wastewater,　nitrate　accumulation　in　the　effluent,　and　the　influence　of　organic　matter.　The　characteristics　and　advantages　of　novel　anammox-coupled　processes,　including　partial　nitrification　and　partial　denitrification　coupled　anammox,　endogenous　partial　denitrification　coupled　anammox,　and　denitrifying　anaerobic　methane　oxic　coupled　anammox　are　also　comprehensively　discussed;　these　aim　to　ensure　the　highly　efficient　and　stable　operation　of　anammox　under　diverse　wastewater　conditions　by　constructing　a　composite　biological　nitrogen　removal　system　based　on　anammox,　supplemented　by　nitrification-denitrification　and　other　processes.　Additionally,　a　novel　anammox　application　route　including　mainstream　partial　denitrification/anammox　and　absorptionbiodegradation　as　well　as　sidestream　partial　nitrification/anammox　is　proposed,　and　its　application　pathway　in　conceptual　wastewater　treatment　plants　is　outlined,　aiming　to　foster　the　development　of　cost-effective,　efficient,　and　energy-saving　advanced　wastewater　treatment　processes.　Finally,　prospects　are　presented　that　indicate　the　gaps　in　contemporary　research　and　potential　future　research　directions.　Overall,　this　review　provides　a　reference　for　treating　municipal　wastewater　with　anammox　and　sheds　new　light　on　related　strategies　and　nitrogen　removal　mechanisms.