The Challenge of Skull Base Closure: Methods for Reducing Postoperative Cerebrospinal Fluid Leak

BACKGROUND: With recent advances in endoscopic skull base surgery, larger and more complex skull base defects are encountered and many possible reconstructive methods and materials are available. The purpose of this review is to summarize the possible causes of skull base defects, to describe the challenges associated with skull base reconstruction, and to detail the techniques and materials that may be used. METHODS: Literature review. RESULTS: Although skull base defects may be caused by traumatic or nontraumatic causes, this review focuses on the endoscopic reconstruction of defects. Many materials are available for endoscopic reconstruction and several techniques have been described for repair of skull base defects. With these advances, the outcomes of endoscopic skull base reconstruction have improved greatly over the past 20 years. CONCLUSIONS: Given the complexity of skull base defects and the multiple materials and techniques available for endoscopic reconstruction, a thorough understanding of the challenges associated with skull base repair is crucial for the endoscopic skull base surgeon.