Endonasal skull base surgery (see Fig. 1 
Fig. 1

Depending on the nature of the surgery, violation of the skull base may be inevitable and is not uncommon during skull base surgery, regardless of the surgical approach. Several techniques for defect repair exist, but all are predicated on graft placement at the defect site (with the exception of the pedicled flap approach). It has been noted that, with current surgical tools, endonasal manipulation and placement of these grafts is difficult [2].

Endonasal graft placement is difficult for a variety of reasons. First, tool manipulability is severely limited by the narrow nasal passage; the surgeon’s first challenge is maintaining control of the small graft (potentially as small as one mm) as the tool traverses from the nasal passage to the skull base defect. Further complicating the task of positioning this graft is the high...

References

References
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Kim
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Russell
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Prevention and Management of Skull Base Injury
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Zanation
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Parmar
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Harvey
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Reconstructive Options for Endoscopic Skull Base Surgery
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Otolaryngol. Clin. N. Am.
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