This review describes the sequential learning from initial free tissue grafting reconstructive techniques to the current use of vascularized flaps. Outcomes and limitations of current endoscopic reconstructive techniques are discussed, including a systematic review of the outcomes of endoscopic endonasal techniques to reconstruct large skull base defects (ESBR). The various endoscopic techniques for local and regional flaps in skull base reconstruction are described. Additionally, EMBASE (1980-December 7, 2010) and Medline (1950 - November 14, 2010) were searched using a search strategy designed to include any endoscopic endonasal reconstruction of the skull base. The manuscripts selected were subject to full text review to extract data on perioperative outcomes for ESBR. Surgical technique was used for sub-group analysis.