Prognosis was once considered hopeless for many patients with malignant neoplasms of the anterior skull base. Craniofacial resection of these lesions has now been found curative for many patients. However, massive resections of the anterior skull base pose many potentially life-threatening complications. Cerebrospinal fluid fistula with meningitis is especially troublesome when previous radiation therapy compromises wound healing. In such circumstances local tissue flaps and skin grafting may not provide reliable separation of the brain from the nose. The pectoralis major myocutaneous flap was utilized in nine patients undergoing antero-lateral resection of the skull base. Several major advantages of this technique include: Reliable closure of the subarachnoid space. Acceptable cosmesis. Rapid wound rehabilitation, allowing early postoperative radiation therapy when necessary.