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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 of Vesalius

  • Sphenoidal Emissary vein
  • 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)


Inferior Orbital Fissure

  • Infraorbital artery, vein, and nerve (V2 branch)
  • 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