Abstract
The nasoseptal flap (NSF) has become the workhorse of endoscopic skull base reconstruction (ESBR). With the increase in endoscopic skull base procedures, there has also been the need for staged and revision procedures where the use of the NSF is no longer an option. These cases have posed new and interesting challenges to skull base surgeons especially with regards to reconstructive options. While free mucosal or turbinate grafts may be too small for certain defects, others such as the pericranial flap require an open procedure with added morbidity. We describe the use of a random nasoseptal flap for the reconstruction of a skull base defect.