Harvesting a Pericranial Flap

The pericranial flap (PCF) is an invaluable resource for skull base reconstruction and has been considered the method of choice to repair skull base defects before the description of the nasoseptal flap (NSF) and the widespread adoption of the endoscopic endonasal approach. The PCF maintains the potential for the largest area of coverage and remains a versatile alternative to the NSF when this is not a viable option. Historically, the PCF has entailed large incisions with suboptimal cosmetic results. However, endoscopic harvesting of this flap has allowed for minimal adverse effects and provides better visualization during flap rotation to prevent torsion of the flap pedicle. The aim of this chapter is to outline the surgical technical nuances for PCF harvesting and routing, including the transcranial, endoscopic endonasal, and endoscopic transorbital approaches.