• Davide Mattavelli, Alberto Schreiber, Marco Ferrari, Remo Accorona, Andrea Bolzoni Villaret, Paolo Battaglia, Paolo Castelnuovo, and Piero Nicolai.
• Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy. Electronic address: davide_mattavelli85@yahoo.it.
• World Neurosurg. 2017 May 1; 101: 486-492.

AbstractWatertight reconstruction to separate the intradural compartment from the sinonasal cavities is crucial after endoscopic resection with transnasal craniectomy for nasoethmoidal tumors. A 3-layer reconstruction with the iliotibial tract is a safe and reliable alternative when vascularized flaps are unavailable. The iliotibial tract graft is harvested on the lateral aspect of the thigh and divided into 3 portions, which are positioned in a multilayered fashion to close the skull base defect: the intracranial intradural layer (first layer), the intracranial extradural layer (second layer), and the extracranial extradural layer (third layer). Fat grafts from thigh subcutaneous tissue are placed between the second and third layers to fill the dead space between them. Use of fibrin glue and intradural irrigation may help the surgeon to stabilize the layers during reconstruction. Three-layer reconstruction with the iliotibial tract is a feasible, highly reproducible, safe, and always available option for reconstruction of anterior skull base defects after endoscopic resection with transnasal craniectomy for nasoethmoidal tumors.Copyright © 2017 Elsevier Inc. All rights reserved.

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