Microvascular reconstruction of the skull base

Cranial base reconstruction is challenging, not only because of its technical difficulty, but also because of the potentially life-threatening complications that may arise in the case of reconstructive failure. Thus, a successful outcome following skull base tumor ablation often depends as much on the reconstruction as it does on the resection. Before the advent of free tissue transfers, cranial base surgery was often limited by our inability to repair defects adequately. Free tissue transfer has been shown to be safe and effective in skull base reconstruction, and provides an opportunity for wide surgical excision of dura and skull base structures to obtain tumor-free margins. With proper patient selection and with strict adherence to the basic principles of cranial base reconstruction, including watertight dural repair and the use of well-vascularized tissue to cover the exposed dura and obliterate the dead space, successful cranial base reconstruction can be achieved.