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The gold standard surgical procedure for these cancers has traditionally been the open craniofacial resection. Endoscopic endonasal approaches emerged in the last two decades as a viable alternative for carefully selected patients. The rarity and heterogeneity of the cancers precludes randomized controlled trials. Evidence for surgical approaches is based on case series and multi\u2010analyses. Current evidence demonstrates that endoscopic approaches do not compromise survival and have lower complication rates. 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