Paranasal sinus cancer usually presents at an advanced stage to the neurosurgeon, with ethmoid sinus involvement and incipient or actual invasion of the anterior cranial fossa floor; in the past this has usually been associated with a poor prognosis. Our experience with 67 patients using craniofacial resection at the Royal Melbourne Hospital, Australia, between June 1983 and June 1995 has produced a 5-year survival of 80% with no deaths and a low rate of serious complications. This appears to represent a significant improvement in the long-term results compared to conventional surgery and radiotherapy. We believe that a major improvement in tumor control can be achieved using careful surgical techniques, and we place special emphasis on the use of a vascularized pericranial flap in the reconstruction of the floor of the anterior cranial fossa. An overview of paranasal sinus cancer is presented, with particular emphasis on our experience with craniofacial resection for these tumors.