Introduction: Endonasal endoscopic approach is one of the most important advences in neurosurgery. Since the begining of the XX century until now, the evolution has allow to increse the security, the extension and the results.

Methods: We performed a descriptive and retrospective work of the first 39 cases operated in our center by endonasal endoscopic approach. The sample includes 39 cases operated in Abel Santamaría Cuadrado General Hospital between 2015 and 2017. The source of information were the clinical histories as well as the operatory documents. Age, sex, pathology, etc. were collect and processed. Descriptive statistical analysis was performed. Based in our initial experience, we suggest some high yield tenets for the beginners in this approach.

Results: From 39 patients operated by endonasal endoscopic approach, 29 corresponded to pituitary macroadenoma, 5 were cerebro-spinal fluid (csf) leaks, 3 were craniopharyngioma, 1 was a meningioma of the optic nerve sheath and 1 chordoma of the clivus. The 85% of pituitary macroadenoma were non-functional and 65% presented with improvement of the visual defect after the surgery. The 5 cases with csf leaks were traumatic and the use of polyuretano locally contribute to the seal of the defect. The craniopharyngiomas presented all 3 with hyponatremia and diabetes insipidus. Though 2 patients get recovered 1 dead. The meningioma of the optic nerve sheath stayed vision equal after surgery. Only one report of this approach was found. The giant chordoma of the clivus was partially resected and irradiated. The patient died 1 year later. HIGH YIELD TENETS FOR THE BEGGINERS: 1. Team work is essential. 2. Hard pre-surgery preparation. 3. Philosophy of work.

Conclusions: In our center we have incorporated the endonasal endoscopic approach with good results based in hard preparation and team working. This surgery most be apply with a new philosophy of work, keeping our minds opened.

Patient Care: This work reflects our young experience with endonasal endoscopic approach and how do the young neurosurgeons can face with success this challenging begining. So better initiation, better results with the patients.

Learning Objectives: By the conclusion of this session, participants should be able to: 1. Know the young experience of our center in the endonasal endoscopic approach. 2. Appreciate a the same standard approach butsince our iniciating experience. 3. Share with our collegues what we consider is the cornerstone in the successful begining of this surgery since our results.

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