Skull base depression is an injury disorder that produces clinical symptoms due to the abnormal protrusion of the dentate process into the greater occipital foramen from various causes, causing ventral compression of the medulla oblongata. The complex anatomy and biomechanical characteristics of the craniocervical junction area make its surgical treatment tremendously challenging. For decades, the classic transoral approach to dentatectomy has become the standard procedure and is widely used in clinical practice. Although the transoral approach has the advantage of direct exposure of the dentition, there are many drawbacks to this procedure. For example, it requires the use of a mouth opener, which inevitably causes tooth damage and tongue compression and swelling; the soft palate and even the hard palate need to be cut when the exposure is inadequate; the surgery is more traumatic and affects postoperative vocalization; due to postoperative swelling of the breathing tube, the tracheal intubation time needs to be prolonged or even tracheotomy is performed; postoperative feeding is not normal and nasal feeding is required, which increases the patient’s pain; bacteria in the oral saliva also increases the risk of postoperative infection The bacteria in oral saliva also increase the risk of postoperative infection; and the deeper operative field and restricted view. In recent years, with the rapid development of neuroendoscopic technology, it has become possible to release the ventral compression of the medulla oblongata by simple endoscopic dentatectomy. However, this surgical procedure is still in its infancy and is only performed in a few medical centers internationally. Through clinical cases, we have learned that the endoscopic transnasal approach for dentatectomy has the following advantages: (1) It allows for a close, wide-angle panoramic view of the operative field, eliminating surgical dead space and allowing the operator to operate under a clearer field of vision, making the procedure safer and minimally invasive. (2) The surgical incision is located in the nasopharynx, which is higher than the mucosal incision through the oral approach (oropharynx), so it does not affect the reasoning of eating, and the patient can eat normally in the early postoperative period without the need to keep a gastric tube for nasal feeding. All of our patients ate normally on the second postoperative day, thus reducing their postoperative pain. (3) The traditional transoral approach requires incision of the soft palate and the application of retractors, which can easily lead to swelling of the tongue, oropharyngeal mucosa and other upper respiratory passages and affect the early removal of the tracheal tube, and some patients even need to undergo tracheotomy, causing additional pain to the patients. In contrast, the endoscopic transnasal approach has little impact on the respiratory passages, and the tracheal intubation can be removed early after surgery, which greatly reduces the patient’s pain. (4) The incision of the transoral approach is located in the oropharynx, which is always in the infiltration of saliva, and postoperative wound infection is very likely to occur. The endoscopic transnasal approach incision is located in the nasopharynx, which avoids saliva contamination and reduces the possibility of postoperative infection. (5) The traditional transoral approach sometimes requires incision of the soft palate or even the hard palate due to inadequate exposure, which increases trauma. The scars formed by the healing of the pharyngeal and soft palate wounds after surgery may cause dysphonia in patients who undergo transoral approach. At present, there are few reports in the literature on endoscopic transnasal approach, and our experience is that (1) the integrity of the middle pterygoid sinus and middle turbinate is preserved by not opening the sinuses and not removing the middle turbinate. The anatomical landmarks were identified. In our opinion, the surgical operation of this approach is mainly located below the level of the middle turbinate, and preserving the middle turbinate bilaterally does not affect the operative space, and preserving the middle turbinate facilitates the laminar flow of air in the nasal cavity, keeps the nasal cavity moist and reduces postoperative wound crusting. Intraoperative neuronavigation also helps to identify important anatomical landmarks without opening the anterior wall of the pterygoid sinus. This allows for a more minimally invasive operation. (2) Bilateral nasal aperture approach and removal of a small amount of bone from the lower posterior part of the bony nasal septum to form a wider access, which allows for a “two-person, four-handed” operation if necessary, allows for a more satisfactory operative space and flexibility. The nasal spreader was placed between the middle turbinate and septum at the beginning of the operation to obtain the operating space. However, the author believes that the use of a single nostril and the use of a nasal spreader is the cause of the narrow operating space. One of the advantages of microendoscopy is to use the natural space of the nasal cavity to meet the operating space, while nasal spacers can affect the flexibility of endoscopic operation. (3) For those who have severe dural compression, the posterior ligament and dura are weak, which may cause dural tear and cerebrospinal fluid leakage. Cerebrospinal fluid leakage has been a difficult problem in endoscopic skull base surgery because of the difficulty of effectively suturing the dura mater through the endoscopic transnasal approach. We have used endoscopic transnasal approach to treat craniopharyngioma, pituitary tumor and slope tumor in the suprasellar third ventricle, and have accumulated a lot of experience in skull base reconstruction surgery, and at the same time, the use of skull base multi-layer reconstruction technique together with continuous postoperative cerebrospinal fluid drainage can effectively prevent and treat the occurrence of cerebrospinal fluid leakage. The effectiveness of this approach is well demonstrated in example 2 of this paper. (4) Because of the deep location of this surgical area and the adjacent important anatomical structures, high surgical precision is required. The combination of intraoperative navigation and an X-ray “C” arm scanner is essential to identify important anatomical structures, guide the direction of surgery, and determine the extent of dentate resection. In addition to the transnasal approach, there is also a transcervical approach for endoscopic dentatectomy. Just as the concept of microsurgery has brought about a profound revolution in neurosurgery, the development of endoscopic techniques will certainly bring about an impact and change to many traditional ideas and surgical approaches. In any case, it needs to be based on the widespread availability of endoscopic surgical techniques. Another direction of development in the surgical treatment of skull base depression is the posterior cervical fixation and repositioning technique, which can enable many patients to perform only posterior cervical occipital fixation and reposition the dentate in the anterior and inferior direction, thus relieving many patients from the pain of anterior cervical resection of the dentate. It can be seen that the development of new neurosurgical techniques has made the surgical treatment of skull base depression develop in a more minimally invasive and simplified direction, and we must learn and master these new methods and techniques in order to design a reasonable and personalized treatment plan according to the patient’s specific situation.