Airtight compartmentalization of the anterior skull base reconstructed using a pedicled pericranial periosteal flap: illustrative case.

Anterior skull base surgery to address tumor, trauma, or infection causing extensive bony destruction is associated with rhinorrhea and infection as potentially life-threatening complications. When performing anterior skull base reconstruction, watertight dural closure and airtight closure of the nasal cavity mucosa are essential for preventing these complications. The authors describe the case of a patient with a mixed olfactory neuroblastoma and adenocarcinoma who underwent resection. The procedure involved a multilayer reconstruction of the skull base, combining fascia lata from the thigh, a pedicled pericranial periosteal flap, and a pedicled nasoseptal flap. Specifically, the authors achieved airtight compartmentalization by carefully suturing the pedicled pericranial periosteal flap to the normal dura mater. This suture technique for placing a pedicled pericranial periosteal flap from the frontal bone in the epidural space might support the goal of achieving a watertight and airtight closure. https://thejns.org/doi/10.3171/CASE25422.