One of the most common combined approaches to skull base tumors includes a transcranial and endoscopic endonasal approach to the anterior and central skull base. Independently these are two common operative procedures employed in the modern treatment of skull base lesions, and have been favored over other historical approaches such as craniofacial, transfacial, and midface degloving due to decreased morbidity and mortality. When these approaches are combined, they add a new solution to the neurosurgeon’s armamentarium, providing a relatively minimally invasive approach with maximal resection in indicated complex lesions.

Combined skull base approaches have become increasingly popular to address intracranial and head and neck lesions. Improved endoscopic visualization, endoscopic tools, and surgical techniques have allowed safer and more ready access to difficult regions in the skull base. Historically, the parapharyngeal space and infratemporal fossa have been considered distinct locations in the head and neck that have been a challenge to access. This chapter details endoscopic endonasal, transoral, and transcervical approaches, along with a review of general indications, utility, and microsurgical anatomy.