The advantages of endoscopic trans-nasal surgery on the base of the skull include the absence of the outer incision, minimal damage to the soft tissues and bones, improved quality of visualization, extended access to the affected sites with the use of the lateral optical systems, the favourable outcomes of the surgical interventions with the small number of complications, the rapid postoperative recovery of the patients, the reduced duration of hospitalization combined with cost effectiveness. In the recent decades, endonasal surgery has been making use of a variety of approaches beginning from the access through the cribriform plate of ethmoid bone and ending with that to the base of the skull structures up to the craniocervical junction and (in the transverse direction) the infratemporal fossa or the petrous apex of the temporal bone. The objective of the present work was to describe the major endoscopic trans-nasal approaches to the base of the skull employed in the otorhinolaryngological practice that have been proposed during the last decades with special reference to the main historical periods of this activities and the key problems related to the post-operative complications.