Airtight compartmentalization of the anterior skull base reconstructed using a pedicled pericranial periosteal flap: illustrative case.

backgroundAnterior skull base surgery to address tumor, trauma, or infection causing extensive bony destruction is associated with rhinorrhea and infection as potentially life-threatening complications. When performing anterior skull base reconstruction, watertight dural closure and airtight closure of the nasal cavity mucosa are essential for preventing these complications. OBSERVATIONS: The authors describe the case of a patient with a mixed olfactory neuroblastoma and adenocarcinoma who underwent resection. The procedure involved a multilayer reconstruction of the skull base, combining fascia lata from the thigh, a pedicled pericranial periosteal flap, and a pedicled nasoseptal flap. Specifically, the authors achieved airtight compartmentalization by carefully suturing the pedicled pericranial periosteal flap to the normal dura mater. LESSONS: This suture technique for placing a pedicled pericranial periosteal flap from the frontal bone in the epidural space might support the goal of achieving a watertight and airtight closure. https://thejns.org/doi/10.3171/CASE25422.