Malignant tumors in the central region of the skull base are rare clinically, with rapid tumor growth and extremely complex anatomy adjacent to each other, involving comprehensive treatment in multidisciplinary fields. Traditional craniotomy to remove the tumor is the main treatment modality, but it requires craniofacial incision and bone flap, and prolonged stretching of brain tissue to expose the tumor, which is very likely to cause damage to appearance and neurological function. At present, the transnasal endoscopic approach has achieved good recognition in the treatment of benign anterior and middle skull base tumors. However, the treatment of malignant tumors is still controversial, and the main issues are: 1. whether the technical standard of endoscopic surgical resection of tumors can remove as much tumor as possible and relieve clinical symptoms. 2. whether non-whole tumor removal affects survival time. 3. Whether the endoscopic surgery is a bottom-up approach, which lacks sufficient visual field and anatomical reference, and whether it will cause damage to vascular and neural structures. 4.Whether the large skull base defect caused by tumor resection can be safely and effectively handled. Surgical technique: The purpose of skull base malignant tumor surgery is to remove the tumor as much as possible while ensuring the patient’s survival quality. The endoscopic transnasal surgical approach is able to reach the midline region between the frontal sinus and cervical 2, including the bilateral cavernous sinuses, pterygopalatine fossa and intraorbital structures. The surgical approach can be refined into multiple procedures, allowing for the removal of malignant tumors that invade different areas. When choosing the endoscopic transnasal approach for the treatment of malignant tumors in the central region of the skull base, factors such as the extent of tumor invasion, the patient’s age and health status should be taken into consideration, and the indications for surgery should be strictly controlled. It should be emphasized that perfect preoperative neuroimaging and rich knowledge of skull base anatomy enable the operator to better identify important anatomical landmarks; while skilled microscopic operation and good teamwork can timely and effectively deal with intraoperative emergencies, thus expanding the indications for endoscopic surgery. Endoscopic close illumination combined with the lateral view feature can provide multi-angle observation and establish three-dimensional view, better reveal the tumor boundary and scope, and improve the negative rate of tumor margin. In some complex cases, it can be combined with intraoperative navigation to accurately locate the spatial position of the tumor and its adjacent, and minimize the surgical damage. Meanwhile, we believe that: because the endoscopic approach avoids the destruction of normal tissue structures during craniotomy, it reduces the chance of tumor dissemination and decreases the risk of local recurrence. However, if the lesion involves the orbital contents, internal carotid artery and other important structures, surgical resection should not be performed forcibly, and the aim should be to reduce the main symptoms of the patient and improve the subsequent treatment effect. The choice of skull base reconstruction: The purpose of skull base reconstruction is to prevent complications such as postoperative cerebrospinal fluid leakage and intracranial infection, and also to provide an important barrier for normal intracranial tissues. The existing reconstruction techniques mainly use multilayer free flap graft. (However, malignant tumors forming skull base defects are relatively complex and require more complete reconstruction means. If the dura mater at the skull base is intact, skull base reconstruction is generally not performed. For smaller dural defects of the skull base, the thigh muscles and broad fascia can be used for effective closure. For anterior skull base bony and dural defects larger than 75px in diameter, it is still recommended to use capitellar-periosteal reversal repair with blood flow to achieve good watertightness. Repair of dural defects after localized bone destruction in the posterior wall and slope of the pterygoid sinus is difficult and requires taking a larger broad fascia to adhere to the breach, which needs to be adequately filled with a large piece of fat to compress and eliminate the dead space. Some scholars believe that the incidence of cerebrospinal fluid leakage after endoscopic surgical skull base reconstruction is high because the tissue materials used are mostly bloodless. However, the reliable results of skull base reconstruction in this group confirmed that autologous free tissue is still a reliable repair material. In addition, a variety of tipped tissue flaps have been gradually used for endoscopic transnasal approach to repair skull base defects, which has improved the success rate of reconstruction Individualized treatment and prognosis: The diverse types of tumor tissue originating from this region have caused differences in patient progression and survival rates, and individualized treatment plans need to be developed according to the pathological nature of the tumor. Meanwhile, invasive skull base tumors are mostly T3 or T4 stage and should be treated with combined treatment modalities, including preoperative biopsy, adjuvant radiotherapy, and surgical treatment. The four cases of olfactory neuroblastoma in our group were treated by surgical resection combined with postoperative radiotherapy, and the patients could obtain a better survival. In contrast, chondrosarcoma of the skull base has a low rate of total resection and poor sensitivity to radiotherapy, but patients can be treated with multiple transnasal endoscopic surgeries, and patients with well-differentiated chondrosarcoma can achieve a 5-year survival rate of 56-87%. Endoscopic surgery is also a good treatment for patients with nasopharyngeal carcinoma who are insensitive to radiation therapy or have recurrence. The transnasal endoscopic approach provides patients with the opportunity to undergo multiple surgeries and reduces hospitalization and postoperative recovery time, resulting in a better quality of life in the immediate postoperative period. In contrast, close and effective observation and follow-up in the long term allows early detection of tumor recurrence and allows patients to be treated. In conclusion, endoscopic transnasal approach through the normal physiological orifices of nasal cavity and sinuses avoids the destruction of normal tissues and structures during craniotomy, reduces various complications and also decreases the chance of local tumor dissemination, which is a safe and effective method to treat malignant tumors in the central area of skull base.