Coverage of skull base defects

Successful reconstruction of the cranial base requires a knowledge of this complex anatomic area, a careful assessment of the defect, a healthy respec t for the potential for ascending infection and meningitis, and reliable te chniques to effectively contain the intracranial space with vascularized ti ssue. The first step in reconstruction is a secure dural repair, which must be covered by a healthy vascularized layer. The scalp contains galeal and pericranial flaps, which are usually incorporated into the reconstruction. Sometimes, along with local muscles such as the temporalis, these local tis sues are all that is needed to complete the reconstruction When the defects are larger and in irradiated beds, free tissue transfer has emerged as the most reliable method to bolster the dural repair.