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Background: Endoscopic transnasal skull base surgery had started long time ago in different centers around the world for excision of skull base lesions with good results and more cost effectiveness. The aim of this study is to discuss our early results in endoscopic skull base surgery and the development of the learning curve. Patients and Methods: We analyzed our experience regarding 25 patients presented to us in Neurosurgery Department,

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Skull base reconstruction of the anterior cranial fossa after the excision of large sinonasal or skull base tumors is still a challenge. The local flaps may be not available or insufficient to seal the whole defect. Harvesting regional flaps or free flap is a time-consuming procedure that may increase postoperative morbidity. We report a technique for reconstruction of anterior skull base using autologous grafts covered by free mucosal graft that is augmented by vascularized flaps in 2 cases. A 51 years old female patient with olfactory neuroblastoma underwent endonasal endoscopic resection followed by multilayer reconstruction using 3 layers of fascia lata sandwiched between a mucosal graft from above and double middle turbinate flaps from below. The second case was 48 years old male patient with non-intestinal type adenocarcinoma invading the anterior skull base. The resection of the tumor was done endoscopically and 3 layers of fascia lata were utilized and covered by a mucosal graft from above and the nasoseptal flap from below for reconstruction. No postoperative CSF leak was reported in either case. The graft augmented flap technique was effective that prevent postoperative morbidity.