As an alternative method to endoscopic endonasal surgery of the paranasal sinuses the authors present their technique based on the use of a microscope with the help of a 25 degrees-30 degrees rigid endoscope to visualize anatomic sites which cannot be reached by microscope. This technique is called "Combined endonasal microsurgery" (CENM). Aspects of the anesthesia and the surgical procedure are discussed. With the combined technique described the goals of the endoscopic endonasal surgery may be achieved as well, being especially interesting for cases with large naso-sinusal polyposis.