Endoscopic endonasal approaches are being used with increasing frequency to provide access to virtually any anterior cranial base, clival, or anterior craniocervical pathology. There have been significant advances in skull base surgery over the past 30 years. Better imaging techniques led to novel surgical approaches, endoscopic surveillance resulted in a greater variety of minimal invasive procedures. The major potential advantage of the endoscopic approach to the skull base is that it provides a direct anatomical route to the lesion without traversing any major neurovascular structures and obviating any brain retraction.