Skull Base 2010; 20(6): 397-404
DOI: 10.1055/s-0030-1253573

© Thieme Medical Publishers

How to Choose? Endoscopic Skull Base Reconstructive Options and Limitations

Mihir R. Patel1 , Michael E. Stadler1 , Carl H. Snyderman2 , 3 , Ricardo L. Carrau4 , Amin B. Kassam5 , Anand V. Germanwala6 , Paul Gardner2 , 3 , Adam M. Zanation1
  • 1Department of Otolaryngology–Head and Neck Surgery, University of North Carolina School of Medicine Memorial Hospitals, Chapel Hill, North Carolina
  • 2Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
  • 3Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
  • 4Department of Otolaryngology–Head and Neck Surgery, Saint John's Health Center, Santa Monica, California
  • 5Division of Neurological Surgery, University of North Carolina School of Medicine Memorial Hospitals, Chapel Hill, North Carolina
  • 6Department of Neurological Surgery, Saint John's Health Center, Santa Monica, California
Further Information

Publication History

Publication Date:
11 May 2010 (online)


As endoscopic skull base resections have advanced, appropriate reconstruction has become paramount. The reconstructive options for the skull base include both avascular and vascular grafts. We review these and provide an algorithm for endoscopic skull base reconstruction. One hundred and sixty-six skull base dural defects, reconstructed with an endonasal vascular flap, were examined. As an adjunct, avascular reconstruction techniques are discussed to illustrate all options for endonasal skull base reconstruction. Cerebrospinal fluid (CSF) leak rates are also discussed. Small CSF leaks may be successfully repaired with various avascular grafting techniques. Endoscopic endonasal approaches (EEAs) to the skull base often have larger dural defects with high-flow CSF leaks. Success rates for some EEA procedures utilizing avascular grafts approach 90%, yet in high-flow leak situations, success rates are much lower (50 to 70%). Defect location and complexity guides vascularized flap choice. When nasoseptal flaps are unavailable, anterior/sellar defects are best managed with an endoscopically harvested pericranial flap, whereas clival/posterior defects may be reconstructed with an inferior turbinate or temporoparietal flap. An endonasal skull base reconstruction algorithm was constructed and points to increased use of various vascularized reconstructions for more complex skull base defects.


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Adam M ZanationM.D. 

Department of Otolaryngology–Head and Neck Surgery, University of North Carolina School of Medicine

CB 7070, 170 Manning Drive, Ground Floor POB, Chapel Hill, NC 27599