● Over the past two decades, there has been a dramatic evolution in the way in which septal perforation with endoscopic techniques are approached and managed ● Fresh-Injected Cadaver Specimens ● Handling of endoscope and camera ● Infundibulotomy, middle metal antrostomy ● Anterior ethmoidectomy ● Intact bulla technique for Draf type I and IIA and posterior ethmoidectomy ● Nasal vascularization (ethmoidal, sphenopalatine and maxillary arteries) ●  Transethmoidal sphenoidotomy with “rescue flap” ● Pedicled flaps (Nasoseptal, inferior turbinate and lateral wall) ● Extended sphenoid sinusotomy and transnasal approach to the pituitary ● Beyond the pituitary – transpterygoid approach ● Transplanum approach ● Exposure of the internal carotid artery and cavernous sinus ● Orbital and optic nerve decompression ● Transfrontal and transcribriform approaches ● Transclival approach ● Meckel’s Cave approach ● Far medial approach (hypoglossal canal) and craniovertebral junction ● 

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