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Surgical Anatomy of Skull Base. Dr. Supreet Singh Nayyar, AFMC For more presentations, visit Topography of Skull Base. Boundaries : Anterior : Incisors upper teeth Posterior: Superior nuchal line Lateral : Upper lateral teeth Zygomatic arch

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Surgical anatomy of skull base

Surgical Anatomy of Skull Base

Dr. Supreet Singh Nayyar, AFMC

For more presentations, visit

Topography of skull base

Topography of Skull Base

Boundaries :

Anterior : Incisors upper teeth

Posterior: Superior nuchal line

Lateral : Upper lateral teeth

Zygomatic arch

Mastoid process

Topography of Skull Base

Anterior Skull Base

Central Skull Base

Posterior Skull Base

Skull Base Anatomy Review

  • Key Openings

  • Foramen spinosum

  • Foramen ovale

  • Foramen lacerum

  • Foramen rotundum

  • Foramen magnum

  • Foramen of vesalius

  • Jugular foramen

  • Superior orbital fissure

  • Inferior orbital fissure

  • Optic canal

  • Vidian canal

  • Hypoglossal canal

  • Pterygopalatine fossa

Skull Base Anatomy Review

  • Foramen magnum

  • Medulla oblongata

  • Vertebral arteries

  • Anterior/Posterior spinal arteries

  • Hypoglossal canal

  • Hypoglossal nerve

  • Hypoglossal artery

  • Jugular Foramen

  • Pars nervosa: CN IX, inferior petrosal sinus

  • Pars vascularis: CN X, XI, jugular bulb

  • Foramen Ovale

  • Mandibular nerve

  • Accessory meningeal artery

  • Lesser petrosal nerve

  • Emissary veins

Skull Base Anatomy Review

  • Foramen Spinosum

  • Middle meningeal artery

  • Recurrent branch of mandibular nerve

  • Stylomastoid foramen

  • Facial nerve

  • Stylomastoid artery

Skull Base Anatomy Review

  • Foramen Lacerum

  • Ascending pharyngeal artery- meningeal branch

  • Nerve of pterygoid canal

  • Foramen rotundum

  • Maxillary nerve

  • Artery of foramen rotundum

  • Emissary veins

  • Pterygoid canal

  • Vidian nerve

  • Vidian artery

Skull Base Anatomy Review

Cavernous Sinus

Receives: Superior opthalmic vein Inferior opthalmic vein Sphenoparietal sinus

Drains via: Petrosal sinuses Basilar plexus Pterygoid plexus

Connection: Circular sinus

Contains: CN III, IV, V1, V2, VI

  • Meckel’s Cave

  • Posterior aspect of cavernous sinus

  • Gasserian ganglion (sensory root ganglion of CN V)

  • Optic Canal

  • Optic nerve

  • Ophthalmic artery

Skull Base Anatomy Review

  • Superior Orbital Fissure

  • CN III, IV, V1, VI

  • Middle meningeal artery- orbital branch

  • Recurrent meningeal artery

  • Superior ophthalmic vein

Central skull base

Central Skull Base

Central skull base1

Central Skull Base








4- Auditory Area5- Articular Area6- Infratemporal Foss

1- Pharyngeal Area2- Tubal Area3- Neurovascular Area

Pharyngeal area

Pharyngeal Area

Roof of Nasopharynx

Boundaries of

Nasopharynx :

* Anterior

* Lateral & Posterior

* Inferior

Pharyngeal area1

Pharyngeal Area

Pharyngobasilar fasia

Fossa of Rosenmullar

* Location- above &

behind medial end ET

* Depth- 2.5 cm

* Apex- Carotid canal

opening (post) &

f. ovale, f. spinosum


* Base- below

Foramen lacerum

Tubal area

Tubal Area

Eustachian Tube

Scaphoid fossa

Runs b/w petrous

bone & greater wing


Opening- nasopharynx

Paratubal muscles

Neurovascular area

Neurovascular Area

Important structures are:

Carotid sheath & its contents

Styloid apparatus

Facial Nerve

Carotid sheath

Carotid Sheath

Compact network of aerolar tissue

Carotid canal to arch of aorta

Encloses : ICA above & CCA below


Vagus nerve

Carotid Canal : ICA & Carotid plexus

sympathetic nerve

Parts of ICA

Divided into three compartments

Jugular Foramen

Divided into three compartments

Styloid Apparatus

Bone- Styloid bone

Ligaments- * Stylohyoid

* Stylomandibular

Muscles- * Stylohoid

* Stylopharyngeus

* Styloglossus

Facial nerve

Facial Nerve

Arise from Stylomastoid Foramen


i) Post auricular nerve

ii) Digastric branch

iii) Temporofacial branch

iv) Cervicofacial branch

Auditory area

Auditory Area


fissure of Glaser:

* Chorda tympani

* Ant br of

tympanic artery

Infratemporal fossa

Infratemporal Fossa

Location : below middle

cranial fossa



* Med & Lat Pterygoid M

* Maxillary A

* Maxillary V

* Pterygoid Venous Plexus

* Br of Mandibular N

Pterygopalatine fossa

Pterygopalatine Fossa

Small inverted pyramid shaped fossa




Anterior cranial base

Anterior Cranial Base

Floor of anterior cranial fossa

Floor of Anterior Cranial Fossa

  • Depth of Olfactory

    fossa (Keros classification)

    * Type I – 1-3mm

    * Type II- 4-7mm

    * Type III- 8-17mm

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