The applications of endoscopic techniques have expanded beyond the treatment of inflammatory sinus disease and toward the resection of anterior and middle skull base lesions. Image-guided surgery has emerged as an important tool that compensates for the limitations of surgical endoscopy. The disadvantage of image-guided surgery, however, is its dependence on preoperative imaging data. Intraoperative imaging provides near real-time imaging that has the potential to improve surgical outcomes and reduce operative morbidity. The role of intraoperative imaging in endoscopic sinus and skull base surgery has demonstrated great promise in recent literature. It has had an impact on surgical decision-making during functional endoscopic sinus surgery and the resection of anterior skull base neoplasia. Advances in portable MRI and volumetric CT technology have enhanced the efficiency and safety of intraoperative imaging. Although further studies are required to quantify the precise utility of this new technology, it appears that intraoperative imaging will be an important tool for rhinologic surgery.