Skull Base Reconstruction by Subsite after Sinonasal Malignancy Resection

Simple Summary Sinonasal malignancies involving the skull base often involve extensive resection and complex reconstruction. Reconstruction efforts must aim to prevent postoperative cerebrospinal fluid leak, pneumocephalus, and infection, in addition to restoring paranasal sinus function. Reconstruction after sinonasal malignancy resection is particularly complex, as many typical skull base reconstructive options are limited due to the extent of resection and margins. The nasoseptal flap is a workhorse of skull base reconstruction but is not consistently available, especially in reoperations and settings of advanced locoregional malignancy. This review aims to discuss the particular reconstructive challenges and analyze the current literature on reconstructive practices in all sinonasal subsites.Abstract Reconstruction after the resection of sinonasal malignancies is complex and primarily dependent on the defect size and location. While the reconstructive paradigm for sellar mass resection is well delineated, the challenges associated with reconstruction after sinonasal malignancy resection are less well described. This narrative review will address the goals of reconstruction after both endonasal endoscopic and open sinonasal malignancy resection and reconstructive options specific to these subsites. The goals of reconstruction include repairing cerebrospinal fluid leaks, restoring sinonasal function, providing a nasal airway, and optimizing the patient's quality of life. These goals are often complicated by the anatomic nuances of each involved sinus. In this review, we will discuss the methods of reconstruction specific to each sinonasal subsite and describe the factors that guide choosing the optimal reconstructive technique.