Reconstructive Techniques in Endoscopic Skull Base and Orbital Surgery

Abstract: Advances in endoscopic endonasal surgical techniques and instrumentation have led to an increased ability to resect a wide variety of skull base lesions through an endoscopic approach. However, more complex surgical resections have led to increasingly complex skull base defects that must be reconstructed to prevent postoperative cerebrospinal fluid rhinorrhea and significant morbidity, including ascending bacterial infections. This chapter presents a graded approach to endoscopic skull base reconstruction, with the goal of providing a robust and reliable separation between the sinonasal and cranial cavities based on the location and size of the defect as well as the flow of the intraoperative cerebrospinal fluid leak encountered. Specific concerns regarding reconstruction of the medial orbit are also discussed. Although this chapter is by no means an exhaustive list of reconstructive options for the endoscopic skull base surgeon, several techniques are discussed in detail with regard to both technical aspects and examples of when such reconstructive option mays be used.