Reconstruction of large clival defects after an endoscopic endonasal approach is challenging.

A Extended nasoseptal flap, which adds the nasal floor and inferior meatus mucosa adds a significant area for reconstruction of the clivus. A defect laterally beyond the hypoglossal canals is not likely covered with this variation of the flap. Preoperative CT scans are useful to guide the reconstruction techniques ¹⁾.