Over the past 20 years endoscopy has become an essential part of nearly all surgical specialities. In the field of skull base surgery recent articles describe new applications and highlight improved results in pituitary adenoma removal, vascular decompression surgery, and in the resection of many other skull base tumors. The strength of the endoscope in skull base surgery lies in its ability to see behind bony apices and neurovascular structures, which normally obscure the view of the operating microscope. Paramount to the success of the endoscope in skull base and pituitary surgery is the ability to secure the arm in position. Operating in the confined spaces of the skull, the instability and difficult adjustment of currently available endoscope holding arms is cumbersome for the surgeon and dangerous to the patient. Many surgeons have commented that the currently available endoscope holding arms are inadequate for contemporary applications of endoscopic skull base surgery. In this article we describe a new pneumatically powered endoscope holding arm, which provides the level of stability and ease of adjustment necessary for current and future applications of endoscope skull base surgery.