How I do it: exoscopic minimally invasive pericranial flap harvest for endoscopic anterior skull base reconstruction.

Abstract

The pericranial flap is a reliable option for reconstructing the anterior skull base in extended endoscopic endonasal procedures when the nasoseptal flap is unavailable or insufficient. We describe a minimally invasive and fast technique for harvesting a vascularized pericranial flap using a three-dimensional exoscope through a small frontal incision, with simultaneous endoscopic endonasal placement, for anterior skull base reconstruction. Exoscope-assisted pericranial flap harvest provides excellent visualization, ergonomics, and flap control, enabling reliable orbit-to-orbit coverage of large anterior skull base defects with low donor-site morbidity when intranasal vascularized options are limited.