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Background: Basal meningoencephalocele is a rare pathology that causes the meninges and brain tissue to prolapse through a defect in the base of the skull. Due to the risk of developing meningitis, brain abscess, surgical intervention is necessary for treatment. Methodology/Principal: At the “N.N. Burdenko Center of Neurosurgery”100 patients with meningoencephalocele of the skull base were operated on. Comparison of the efficacy and safety of the use of endoscopic and transcranial approaches for the treatment. Results: In a series of 100 patients, the transcranial approach was used in 44 (44%) cases. The indications for this approach were multiple defects, a depressed fracture of the frontal sinus, defects in the lateral sections of the posterior wall of the frontal sinus. Endoscopic endonasal approach was performed in 56 (56%) cases. The indications for the choice of access were single defects in the sphenoid, ethmoid, medial sections of the frontal sinus, cribrosa plate. The success rate of plastic surgery with endoscopic endonasal access is 86,5% (7 of 56) with transcranial access 95,5% (2 of 44). Conclusions. For the treatment of basal meningoencephalocele transcranial and endoscopic approaches are used. The choice of access depends on the anatomical features and localization of the defect. Key words: meningoencephalocele, skull base, endoscopic approach, sphenoid sinus, ethmoid sinus, frontal sinus.