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Objectives: Malignant tumors of the paranasal sinuses are traditionally approached by a variety of external incisions. Recent advances in endoscopie endonasal surgery have allowed for some of these tumors to be treated endoscopically. The purpose of this study was to assess the outcomes and complications of the endoscopie approach in a series of patients with paranasal sinus malignancies. Methods: A retrospective chart review was performed of patients with sinonasal or skull base malignancies treated with endoscopie or endoscopic-assisted resections at a tertiary care institution from 2002 to 2010. Patient data were collected on symptoms, tumor type, operative technique, and postoperative course. Baseline risk factors, overall and disease-free survival data, and surgical outcomes were compared between the two groups. Results: Of the total 49 patients, 36 (73%) underwent an endoscopie approach and 13 (27%) underwent endoscopic- assisted approaches. Sarcomas (9 cases) were the most common tumor type, followed by squamous cell carcinoma (8), adenocarcinoma (8), and melanoma (7). The mean follow-up time for all patients was 3.58 years (range, 1.1 to 8.8 years). Surgical complications were more frequent with open approaches than with endoscopie approaches (23.1% versus 5.6%; p = 0.11). Medical complications were significantly more common with open approaches (38.5% versus 8.3%; p = 0.02). The disease-specific mortality rate was 8% (4 of 49). The local tumor recurrence rate was 16% (8 of 49). The 3-year disease-free survival rates were 86.8% in the endoscopie group and 67.7% in the open group (p = 0.047); however, the patients in the endoscopie group had lower T stages (p = 0.0068) and lower ASA scores (p = 0.03). Conclusions: Endoscopie approaches to the sinuses and skull base have become progressively more sophisticated with advances in skull base reconstruction, advances in surgical technique, and improvements in technology. This study demonstrates the relative safety and utility of the endoscopie approach for sinonasal and skull base malignancies. In carefully selected patients, endoscopie approaches demonstrate survival rates comparable to those of traditional surgery, and fewer perioperative complications. With appropriate planning and careful surgical decision-making, endoscopie surgery shows promise as a minimally invasive alternative in the treatment of sinonasal malignancies. [ABSTRACT FROM AUTHOR]