Endoscopic endonasal approach to the skull base has numerous advantages such as superb visualization, view around the corner, sparing transgression of uninvolved tissue, and avoiding brain retraction through a direct trajectory. Endoscopic reconstruction of the resulting skull base defect is challenging. Reconstructive failure may lead to potentially lifethreatening complications. Various techniques and materials have been used to reconstruct the skull base defect after tumor resection. The nasoseptal flap, supplied by the septal branch of the sphenopalatine artery, is highly vascularized and adequate in size for reconstruction of most skull base defects from the posterior wall of the frontal sinus to the clivus, serving as a workhorse for skull base reconstruction. In this review, we introduce principles of skull base reconstruction with emphasis on the nasoseptal flap.
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