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Introduction Anterior skull base resection often results in large defects that need to be reconstructed. This can be done using loco-regional, free flaps or both. Objective The aim of this systematic review is to evaluate the surgical outcomes (mortality, complication rates and functional outcomes) for patients undergoing anterior skull base reconstruction. Methods Electronic databases (MEDLINE, EMBASE and Scopus) were systematically searched for relevant articles from 1974 to March 2018. A total of 41 studies were included in this sys