Both benign and malignant lesions involving the skull base occur in one of the most inaccessible areas of the body. Furthermore, surgical resections in this area have been limited by the critical structures located at the skull base and the severity of complications risked with surgery in this area. While neurosurgeons, head and neck oncologic surgeons, and otologists all have their own approach to the skull base, it was not until fifteen years ago that a systematic interdisciplinary surgical approach to the skull base emerged. Essential to the development of these approaches were recent technical advances in preoperative diagnostic evaluation and surgical equipment. Accurate determination of tumor extent through advances in polytomography and computerized axial tomogram scanning has enabled careful patient selection and surgical planning. The surgical endeavor has been made more efficient by the use of the operating microscope and the air drill with constant water suction irrigation.