Reconstruction Following Endoscopic Endonasal Skull Base Surgery: Options and Technical Considerations

Purpose of ReviewTo provide a brief overview of the options available for reconstruction of the skull base and to discuss their technical considerations. To review the contemporary literature surrounding adjunctive measures such as acetazolamide and perioperative cerebrospinal fluid (CSF) diversion.Recent FindingsA recent randomized, control trial examining perioperative lumbar drainage following endoscopic skull base surgery has demonstrated that perioperative lumbar drainage is significantly associated with decreased incidence of postoperative CSF leak in specific anatomical subsites.SummaryMany factors must be weighed when considering proper skull base reconstruction. For large defects, multilayered repair with vascularized tissue is the gold standard. Perioperative lumbar drainage is recommended for large anterior or posterior fossa defects. The effect of acetazolamide on postoperative CSF leak remains unclear. Indocyanine green angiography (ICG) is a promising innovation that can aid in assessment of vascularized flaps.