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Malignant rhinosinonasal tumors are relatively rare and very aggressive, leading to diagnosis in advanced stages.The gold standard seems to be a combination of external or endoscopic approach surgery and radiotherapy. Surgical intervention for the treatment of rhinosinusal tumors must meet certain standards: sufficiently expose the region for the complete resection of the tumor, ensure good postoperative surveillance, and not cause postoperative functional disability. Adequate exposure of the anterior skull base for the excision of neoplasms requires a combined intracranial and extracranial approach. Most commonly, an interdisciplinary approach between neurosurgery and ENT is required. Extensive endoscopic endonasal approaches may be considered for sinonasal malignant tumors of the nasal cavity and paranasal sinuses, including those with involvement and extension through the anterior skull base. After performing the preoperative steps, the endonasal approach starts with correcting access issues, for example: septal deviation and debulking the tumor using a microdebrider. One of the most common complications of extended endonasal approaches in the management of malignant skull base and anterior nasosinonasal tumors is cerebrospinal fluid (CSF) leakage, with an incidence below 5% in centers with significant endoscopic experience and expertise. Although the challenges of endoscopic surgery are quite numerous, in appropriately selected patients, these tumors are increasingly being successfully managed by endoscopic surgical approaches, with low morbidity and mortality.