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

Markus K H Wiedmann; Johan Edvard Steineger; Daniel Dahlberg; Sinan Dheyauldeen

doi:10.1007/s00701-026-06828-0

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

Acta Neurochir (Wien). 2026 Mar 13;168(1):70. doi: 10.1007/s00701-026-06828-0.

Authors

Markus K H Wiedmann¹, Johan Edvard Steineger², Daniel Dahlberg³, Sinan Dheyauldeen^{2

4}

Affiliations

¹ Department of Neurosurgery, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway. Markus.kh.wiedmann@gmail.com.
² Department of Otorhinolaryngology-Head and Neck Surgery, Oslo University Hospital, Oslo, Norway.
³ Department of Neurosurgery, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway.
⁴ Faculty of Medicine, University of Oslo, Oslo, Norway.

Abstract

Background: 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.

Methods: 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.

Conclusion: 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.

Keywords: Endoscopic skull base; Exoscope; Skull base reconstruction; Transphenoidal; Vascularized flap.

MeSH terms

Endoscopy* / methods
Humans
Minimally Invasive Surgical Procedures* / methods
Plastic Surgery Procedures* / methods
Skull Base Neoplasms* / surgery
Skull Base* / surgery
Surgical Flaps*