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Skull base surgery has been transformed by the development of endoscopic endonasal surgery. These techniques were initially developed for paranasal sinus surgery, but their indications have been gradually extended to include endoscopic resection of pituitary tumours, and then lesions of the clivus, olfactory cleft, planum sphenoidale, but also the petrous apex, or infratemporal fossa. Endoscopic endonasal surgery provides access to almost all regions of the skull base situated anterior to the foramen magnum Tumours are the lesions primarily concerned, but cerebrospinal fluid (CSF) leaks of traumatic or other origin, certain chronic infections and congenital malformations are also accessible to endoscopic surgery.