Background: The Endoscopic Transphenoidal Approach to the Skull Base (ETSS) is now used internationally for a wide variety of pathologies ranging from CSF leaks to complex brain tumours. Methods: Case illustrations. Historical review of the evolution of ETSS with a focus on Canada’s contributions. Results: Canadians have been major contributors in the development and advancement of surgery of the skull base, particularly through endoscopic means. These will be highlighted with particular emphasis of those of Hardy, Cusimano, Kassam, Gentili, and others. Conclusions: Canada has been and continues to be an international leader in development and treatment of patients with skull base lesions, particularly those with lesions of the skull base amenable to ETSS.