Anterior skull base reconstruction: a review of current techniques

PURPOSE OF REVIEW: The purpose of this review is to discuss current reconstructive options in anterior skull base reconstruction. RECENT FINDINGS: Free tissue transfer has superseded regional myocutaneous flaps in the reconstruction of large anterior skull base defects. Local flaps remain the mainstay for smaller defects. A host of nonautologous biomaterials are also used in the setting of small-to-moderate-sized defects requiring rigid support. They should not be used in the setting of radiation owing to the high extrusion rate. Lastly, the advent of endoscopic tumor resection has introduced a variety of local flaps amenable to endoscopic reconstruction. SUMMARY: The last decade has experienced a growth in anterior skull base reconstructive options owing to improvements in microvascular technique, endoscopic equipment, image guidance, and biomaterials. As a result, the choices in reconstructive technique have expanded, allowing for more radical tumor extirpations.