Such a giant anterior skull base mucocele involving the orbito-ethmoido-maxillo-fronto sinuses is a rare case. This patient complained of a right orbital mass for 18 years, and he was recommended to our hospital for treatment. His history, physical examination, laboratory study results, diagnosis, and treatment are reported in detail. In conclusion, we show that modified transcranial pathway and ingenious assistant incision can get the utmost exposure and can obtain a satisfactory aesthetic result and that anterior skull base reconstruction with the galeal-frontalis-pericranial flap based on the temporalis myofascial flap for the first time can successfully prevent life-threatening complications from happening.