Malignant tumors in the central region of the skull base are clinically rare, with rapid tumor growth and extremely complex anatomical adjacencies, involving comprehensive treatment in multidisciplinary fields. Traditional craniotomy to remove the tumor is the main treatment modality, but due to the need for craniofacial incision and bone flap, and prolonged stretching of brain tissue to expose the tumor, it is very easy to cause appearance and neurological function damage. Currently, the transnasal endoscopic approach has achieved good acceptance in the management of benign tumors of the anterior and middle skull base. However, the treatment of malignant tumors is still debated, and the main issues are: 1. Whether the technical standard of endoscopic surgical resection of tumors is capable of removing the tumor as much as possible and relieving the clinical symptoms. 2. Whether the non-whole tumor resection affects the survival time. 3. Whether the endoscopic surgery, which is a bottom-up approach and lacks sufficient field of view and anatomical references, may result in the damage of vascular and neurological structures. 4. Whether it can be safely and effectively dealt with large skull base defects caused by tumor resection. Surgical Technique: The aim of surgery for malignant tumors of the skull base is to resect the tumor as much as possible under the premise of ensuring the patient’s quality of survival. Endoscopic transnasal surgical access is able to reach the midline region between the frontal sinus and cervical 2, including structures such as the bilateral cavernous sinuses, the pterygopalatine fossa, and the orbit. The surgical approach can be subdivided into multiple surgical modalities, allowing for the removal of malignant tumors that encroach into different areas. When choosing the endoscopic transnasal approach to treat malignant tumors in the central region of the skull base, it is necessary to take into account the extent of tumor invasion, the patient’s age and health status, and other factors, and strictly grasp the indications for surgery. 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 skillful microscopic operation and good teamwork can deal with intraoperative emergencies in a timely and effective manner, thus expanding the indications for endoscopic surgery. The combination of endoscopic proximity illumination and lateral perspective allows multi-angle observation and the establishment of a three-dimensional field of view, which better reveals the boundary and scope of the tumor and improves the negativity rate of the tumor margin. In some complicated cases, it can be combined with intraoperative navigation to accurately locate the spatial position and adjacency of the tumor and minimize the surgical injury. At the same time, we believe that: as the endoscopic approach avoids the destruction of normal tissue structure during craniotomy, it reduces the chance of tumor dissemination and lowers the risk of local recurrence. However, if the lesion involves orbital contents, internal carotid artery and other important structures, surgical resection should not be forced, and the aim should be to reduce the patient’s main symptoms and improve the effect of subsequent treatment. Choice of Skull Base Reconstruction: The purpose of skull base reconstruction is to prevent complications such as postoperative cerebrospinal fluid leakage and intracranial infections, as well as to provide an important barrier to normal intracranial tissues. Existing reconstruction techniques mainly use multilayered free flap grafts. (However, malignant tumors forming skull base defects are relatively complex and require more sophisticated reconstructive means. If the dura mater at the base of the skull is intact, reconstruction of the skull base is usually not performed. Smaller dural defects of the skull base can be effectively closed with thigh muscles and broad fascia. For anterior skull base bony and dural defects larger than 75px in diameter, it is still recommended to use capitellar-tendinous-periosteal flip repair with blood flow to achieve good water tightness. Dural defects after localized bone destruction in the posterior wall and slope of the pterygoid sinus are difficult to repair, and a larger broad fascia needs to be taken and adhered to the breach, and a large piece of fat needs to be used to adequately fill in the compression and eliminate the dead space. Some scholars believe that the incidence of cerebrospinal fluid leakage after endoscopic skull base reconstruction is high because the tissue materials used are mostly without blood transport. 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 applied to endoscopic transnasal approach for repair of skull base defects, which improves the success rate of reconstruction Individualized treatment and prognosis: The diverse types of tumor tissue sources in this region result in the different progression of patients’ conditions and survival rates, which require individualized treatment plans based on the pathological nature of the tumor. Meanwhile, tumors invading the skull base are mostly at T3 or T4 stage, and should be treated with combined treatment modalities, including preoperative biopsy, adjuvant radiotherapy, and surgical treatment. In our group, 4 cases of olfactory neuroblastoma were treated with surgical resection combined with postoperative radiotherapy, and the patients could obtain better survival. 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 can have a better survival, and the 5-year survival rate of patients with well-differentiated chondrosarcoma can reach 56-87%. Endoscopic surgery is also a good treatment for patients with radiosensitive or recurrent nasopharyngeal carcinoma. The transnasal endoscopic approach provides patients with the opportunity to undergo multiple surgeries and reduces hospitalization and recovery time, resulting in a better quality of life in the immediate postoperative period. And close and effective observation and follow-up in the long term can detect tumor recurrence at an early stage and enable patients to be treated. In conclusion, endoscopic transnasal approach through normal physiological orifices such as nasal cavity and sinuses avoids the destruction of normal tissue structure caused by craniotomy, reduces various complications and also reduces the chance of local dissemination of tumors, and is a safe and effective method for the treatment of malignant tumors in the central region of the skull base.