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Endoscopic skull base techniques have advanced greatly over the years owing to various technological advances, including angled endoscopes, high-definition monitors, frameless navigation systems, high-resolution imaging, and improved anatomic knowledge. Perhaps the greatest innovations in endoscopic skull base surgery have come in the treatment of complex skull base defects and cerebrospinal fluid (CSF) leaks. Effective watertight repair of complex defects after skull base tumor resection emerged as the primary limitation to the endoscopic resection of advanced disorders. Thus, the ability to effectively reconstruct defects in this area represents a pivotal step in the ability to pursue endonasal endoscopic approaches. Over the past decade there have been considerable advances in the ability to reconstitute the separation between the intracranial and sinonasal compartments after endonasal skull base …