Reconstruction of the Skull Base

Advances in skull base reconstruction have permitted complete resection of skull base lesions that were previously deemed unresectable due to unreliable soft tissue coverage of the brain, dura, and other critical neurovascular structures as well as unacceptable disfigurement and loss of function. While grafts and pedicled flaps still play a role for selected defects, microvascular free flaps have become the cornerstone of skull base reconstruction. Free flaps provide ample well-vascularized tissue and have reduced complications such as cerebrospinal fluid leak and dural exposure. The location of the skull base lesion determines the approach to resection and dictates the reconstructive needs. The focus now is to improve the cosmesis and function of patients undergoing skull base resection, including restoration of facial movement and tone.