Grafting materials in skull base reconstruction.

Successful endoscopic repair of the skull base may be performed with a variety of grafting materials. Graft materials discussed in this chapter are broadly categorized as autologous tissue, acellular human dermis, engineered collagen products, rigid support materials and tissue glues. Autologous tissues continue to be widely used due to their safety, availability, and low cost. Engineered collagen products and acellular dermis are favored in revision cases and larger repairs. The need for rigid support continues to be an area of controversy as pedicled grafts are increasingly used for larger defects. Tissue glues and sealants, however, are used by many authors. The components of, and evidence for, commonly used sealants are detailed. Relatively little high-quality, comparative evidence exists to guide decision making when selecting graft materials, but where available, this evidence is cited. If surgeon experience and patient characteristics are carefully considered, excellent results can be expected with most materials.