OBJECTIVE: To evaluate the role of Regenerated Oxidised Cellulose (ROC) gauze (Surgicel) as a tissue sealant and adhesive, in addition to its hemostatic role, in the reconstruction of skull base defects following endoscopic endonasal Skull base surgery. METHODS: We retrospectively analyzed the medical records of patients who underwent endoscopic endonasal skull base surgery with skull base defect and intraoperative cerebrospinal fluid (CSF) leak, for which reconstruction was performed using fibrin glue or ROC or both as a sealant and adhesive. Demographic data, approach used, type of intraoperative CSF leak, type of repair performed, type of sealant and adhesive used, and postoperative CSF leak rates with different agents used were analyzed. RESULTS: A total of 64 patients were investigated. Fibrin glue alone was used initially in six (9.4%) patients as a sealant/adhesive, of which four (66.6%) experienced postoperative CSF leak. Both fibrin glue and surgicel (ROC) were used in 26 (46.43%) patients, among which two (7.6%) exhibited postoperative CSF leak. Surgicel (ROC) alone was used as sealant/adhesive in 24 (42.86%) patients, wherein two (8.3%) presented with postoperative CSF leak. Fibrin glue alone was once again used later in the learning curve in eight (12.5%) patients, of which two (25%) experienced postoperative CSF leak (p = 0.002). CONCLUSION: ROC is a useful adjunct in endoscopic endonasal reconstruction of skull base defects with both hemostatic and sealant/adhesive effects and can be used for holding the reconstruction in position until complete healing occurs. KEYWORDS: Surgicel, Regenerated oxidised cellulose, CSF leak, tissue sealant, tissue adhesive.