Endoscopic skull base reconstruction after endoscopic endonasal approach.

Recent advances in technology and techniques in neurosurgery and otolaryngology have revolutionised skull base surgery with the introduction of endoscopic endonasal approaches. One of the greatest limitations of endoscopic endonasal skull base surgery is the repair of osteodural defects. Numerous reconstructive techniques have been developed that maximise endoscopic endonasal approach efficacy and minimise complications. The choice of technique for closure depends on different factors and is based on an individual approach in each patient. In particular, size, the localisation of the defect and the presence of a high-flow CSF leak are major determinants of the reconstructive options. Free tissue transfer remains the mainstay for the reconstruction of smaller defects. However, local vascularised flaps and the nasoseptal flap in particular now play a pivotal role in the reconstruction of larger defects. These flaps have significantly reduced the morbidity and risk of post-operative CSF leaks after endoscopic endonasal approaches.