Functional endoscopic sinus surgery was initially introduced as a minimally invasive procedure to treat chronic rhinosinusitis (CRS) in patients for whom medical management failed. Sinus surgery has been deemed an extremely effective part of the overall management of chronic sinus disease with symptomatic improvement in the vast majority of patients. At the forefront, technologic advances have been critical in advancing endoscopic sinus surgical procedures. With the introduction of improved optics and lighting, advanced instrumentation, and image-guided surgical navigation, the limitations of endoscopic procedures have been significantly reduced. Endoscopic techniques have evolved to include the management of both malignant and benign neoplasms of the sinuses and anterior skull base. This article highlights some of the newest advances in technology, materials, and medical/surgical techniques used in endoscopic sinus and skull base procedures and illustrates how they advance overall patient care to help minimize morbidity and complications. © 2010 Elsevier Inc.