At early history of neurosurgery, the use of extended craniotomy was dictated by poor illumination, inadequate visualization, and the lack of accurate diagnosis. The technological progress development and the emergence of highly informative neuroimaging, microscopy, and neuroendoscopy minimized neurosurgical approaches and, accordingly, approach-associated complications. At present, the fundamental philosophy of minimally invasive surgery is of particular topicality because this surgery contributes to rapid recovery of patients and reduces the period of hospital treatment. The aim of the article is to provide a brief historical overview of the evolution of surgical approaches to the skull base, ranging from extended craniotomy to minimally invasive interventions.