Skull base reconstruction.

Various surgical techniques for extirpation of anterior skull base tumors have been established over the past few years. Tumors that are located in this anatomical area may invade both soft and hard tissues of the skull base. In such cases, an en bloc tumor resection may create extensive skull base defects and produce a free conduit between the paranasal sinuses and the intracranial space. Following tumor resection, cranial base defects require reconstruction to create a secure barrier between these two compartments. Failure of the reconstruction carries potential life-threatening complications—for example, CSF leakage and meningitis—that may delay the initiation of adjuvant therapy. Reconstruction of anterior skull base is technically challenging and may be further complicated by several factors. First, there is a paucity of local tissue that is available for transfer into the defect. Second, previous radiotherapy significantly reduces tissue perfusion that delays normal wound healing. Finally, many of these patients have undergone multiple surgeries prior to the index operation, thus increasing its complexity and, secondary to scar-tissue formation, decreasing tissue perfusion. This compilation of papers has been arranged in a format that aims to help the reader to evaluate and plan the reconstruction of the skull base following extirpation of tumors. I would like to thank the colleagues who have contributed to this issue, and I am especially grateful to those who have been my dedicated mentors over the years.