Neuroendoscopic surgery encompasses minimally invasive approaches to the skull base using endoscopic techniques. There are unique technologic challenges with endoscopic endonasal skull base surgery, such as a limited working space, difficulty in visualization and identification of neurovascular structures and removal of tissue, hemostasis, and dural reconstruction. Technologic advances that have enabled this surgery include specialized operating suites, neurophysiologic monitoring, imaging and visualization technologies, dissection instrumentation, hemostatic materials, and reconstructive materials. Advances in each of these areas and the needs and challenges of the future of neuroendoscopic surgery are discussed.