Skull base tumours are tumours located in the bony structures at the base of the brain. They may arise from a variety of different tissues found either extracranially, intracranially or directly from the skull base. Despite this diversity in origin, they behave in a rather uniform way: they are frequently benign and only locally invasive, they rarely metastasize and they often prove refractory to radiotherapy or chemotherapy; thus radical surgical resection is the treatment of choice in their management. In the surgical treatment, the rate limiting step in obtaining the goal of a radical surgical resection has been in obtaining the access and exposure of these tumours lying ventral to the brain and posterior to the facial skeleton and aerodigestive system. Advances in surgical techniques however has seen the development of multiple different approaches, often involving a multidisciplinary team including neurosurgeons, plastic surgeons, maxillofacial surgeons and otolaryngologists. Using a Le Fort I osteotomy as initially described by this institution to approach midline lesions is ideal, as the mobilisation of the hard palate and maxilla inferiorly allows for visualisation of the whole clivus. We report our findings and complications in 40 patients treated over the last 13 years with midline skull base tumours using this approach.