The endoscope has traditionally been used in neurosurgery to access a lesion within a natural body cavity. The challenge has been to access and resect deep-seated intraparenchymal lesions using a minimally invasive endoscopic technique. Endoscopic endonasal trans-sphenoidal surgery has gained increasing acceptance by otolaryngologists and neurosurgeons. Surgical procedures of the skull base include exposure, resection, and base reconstruction. These approaches start at the sphenoid sinus, which provides a reference point to important vascular and neural structures. The endoscopic endonasal approach is optimal in paramedian ventral skull base tumors, allowing wide access to the ventral skull base regions and allowing early devascularization of the tumor without retraction of the brain. Limited exposure results in limited "injury" to surrounding tissue and consequently reduced post-operative pain, a shorter length of hospital stay, a reduction in the time to return to work, and decreased overall cost.