Due to its vascular supply and neurovascular contents, the cavernous sinus (CS) is a challenging area to dissect in the setting of skull base tumors with intracavernous extension or invasion. In this study, we present clinical outcomes of 14 patients with tumors with CS invasion that were surgically treated using a direct transcavernous sinus approach for endoscopic endonasal resection of their intracavernous sinus tumors. Fourteen patients were surgically treated using a direct endoscopic endonasal transcavernous sinus approach. Pathologies included Knosp grades 3-4 pituitary adenomas (n=8), meningioma (n=3), squamous cell carcinoma (n=2), and chondrosarcoma (n=1). The indications, surgical technique, and outcomes are discussed. Gross total resection was achieved in 11 cases (78.6%). All patients experienced resolution or improvement of symptoms. One patient experienced a transient oculomotor nerve palsy which resolved within 2 months postoperatively; no other complications occurred. For those tumors which were grossly resected, no recurrence was noted for any case (mean follow-up 40.4 ± 24.8 months, range 10-84). Depending on the space made by the intracavernous sinus tumors, a transanterior wall of CS approach in the endoscopic endonasal surgery adequately treated the majority of patients in our case series. This approach provides good visualization of the CS, and can be used to address tumors with favorable outcomes and a low incidence of complications in appropriately evaluated patients. Copyright ? 2019 Elsevier Inc. All rights reserved.