Reconstruction of the cranial base defect

Cranial base resection and reconstruction is the newest frontier in head and neck cancer surgery. It is following in the footsteps of all previous surgical challenges. Impossibility is the gauntlet. Development of improved imaging allows us to define the extent of the tumor, and the collaboration of diverse disciplines allows us to work out approaches. Reconstruction always begins quite crudely, at first being simply an exercise in hole filling. This is followed by refinement and ultimately the ability to replace what has been lost. In many aspects of head and neck surgery we are already quite sophisticated. Mandibular reconstruction has gone through all these stages and we are now in a position to reconstruct mandibles with bone of sufficient quantity and quality to take dental implants, essentially replacing what was lost. The future of cranial base surgery holds exciting challenges to our ingenuity to refine and develop what has been started.