A technique of antro-ethmosphenoidectomy has evolved over the last 50 years to provide a thorough, yet safe method of treating chronic, recurrent advanced pansinusitis. The trans-antral approach to the ethmoid labyrinth and sphenoid sinuses was first described before the turn of this century. A brief chronological history is reviewed in order to understand the development and then the abandonment of this surgery for over twenty years. This was followed by a renewed interest in the procedure conforming to the modern concepts of nasal physiology and rhinologic surgery. Because of the wide visual surgical exposure, the antro-ethmosphenoidectomy approach is most ideally adapted to pituitary, skull base and orbital decompression procedures.