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The purpose of this review is to discuss current reconstructive options in anterior skull base reconstruction.Free tissue transfer has superseded regional myocutaneous flaps in the reconstruction of large anterior skull base defects. Local flaps remain the mainstay for smaller defects. A host of nonautologous biomaterials are also used in the setting of small-to-moderate-sized defects requiring rigid support. They should not be used in the setting of radiation owing to the high extrusion rate. Lastly, the advent of endoscopic tumor resection has introduced a variety of local flaps amenable to endoscopic reconstruction.The last decade has experienced a growth in anterior skull base reconstructive options owing to improvements in microvascular technique, endoscopic equipment, image guidance, and biomaterials. As a result, the choices in reconstructive technique have expanded, allowing for more radical tumor extirpations.