The sphenoid sinus has been described as the forgotten sinus or neglected sinus because of its anatomical location and the difficulty in diagnosing disease there. Now, modern imaging, antibiotic, and surgical options have changed the presentation and, often, the treatment of sphenoid diseases. With the evolution of the neurorhinological surgical procedures, the sphenoid sinus is now used as a gateway for advanced endoscopic skull base surgery. The aim of this work is to justify the importance of endoscopic transsphenoidal surgery in the management of different sphenoid sinus diseases and other skull base lesions which can be approached through the sphenoid sinus. Over 2 years period we used 4 endoscopic trans-sphenoidal approaches in the management of 30 patients with 14 different lesions. These included the transnasal direct sphenoidotomy, transethmoidal trans-sphenoidal approach, bilateral transnasal paraseptal trans-sphenoidal approach (tow nostrils 4 hands) and transpterygoid trans-sphenoidal approach. The used approach was tailored according to the nature, location, and extension of each lesion. We managed all our patients with different transnasal endoscopic approaches with minimal morbidity and no mortality recorded with short hospital stay in a regular hospital room. These results add to the advantages of endoscopic approaches.