Surgical anatomy of skull base
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Surgical Anatomy of Skull Base. Dr. Supreet Singh Nayyar, AFMC For more presentations, visit www.nayyarENT.com. 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

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Surgical Anatomy of Skull Base

Dr. Supreet Singh Nayyar, AFMC

For more presentations, visit www.nayyarENT.com

www.nayyarENT.com


Topography of Skull Base

Boundaries :

Anterior : Incisors upper teeth

Posterior: Superior nuchal line

Lateral : Upper lateral teeth

Zygomatic arch

Mastoid process

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Topography of Skull Base

Anterior Skull Base

Central Skull Base

Posterior Skull Base

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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

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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

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  • 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

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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

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Skull Base Anatomy Review

Cavernous Sinus

Receives:Superior opthalmic veinInferior 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)

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  • 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

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Central Skull Base

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Central Skull Base

6

1

1

2

5

3

4

4- Auditory Area5- Articular Area6- Infratemporal Foss

1- Pharyngeal Area2- Tubal Area3- Neurovascular Area

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Pharyngeal Area

Roof of Nasopharynx

Boundaries of

Nasopharynx :

* Anterior

* Lateral & Posterior

* Inferior

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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

(lat)

* Base- below

Foramen lacerum

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Tubal Area

Eustachian Tube

Scaphoid fossa

Runs b/w petrous

bone & greater wing

sphenoid

Opening- nasopharynx

Paratubal muscles

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Neurovascular Area

Important structures are:

Carotid sheath & its contents

Styloid apparatus

Facial Nerve

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Carotid Sheath

Compact network of aerolar tissue

Carotid canal to arch of aorta

Encloses : ICA above & CCA below

IJV

Vagus nerve

Carotid Canal : ICA & Carotid plexus

sympathetic nerve

Parts of ICA

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Jugular Foramen

Divided into three compartments

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Styloid Apparatus

Bone- Styloid bone

Ligaments- * Stylohyoid

* Stylomandibular

Muscles- * Stylohoid

* Stylopharyngeus

* Styloglossus

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Facial Nerve

Arise from Stylomastoid Foramen

Branches:

i) Post auricular nerve

ii) Digastric branch

iii) Temporofacial branch

iv) Cervicofacial branch

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Auditory Area

Petrotympanic

fissure of Glaser:

* Chorda tympani

* Ant br of

tympanic artery

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Infratemporal Fossa

Location : below middle

cranial fossa

Boundaries

Contents:

* Med & Lat Pterygoid M

* Maxillary A

* Maxillary V

* Pterygoid Venous Plexus

* Br of Mandibular N

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Pterygopalatine Fossa

Small inverted pyramid shaped fossa

Location

Boundaries

Communications

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Anterior Cranial Base

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Anterior Cranial Base from inside

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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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Thank youFor more presentations, visit www.nayyarENT.com

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