Skull Base Anatomy

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Skull Base Anatomy

Otology/Audiology
Author Credentials 

Dr. Prashant M. Naik, MS (ENT), DLO
21, Central Excise Colony 
Ring Road 
Nagpur (MS) 440015
India

Phone: 0919823298575
Email: prasima@hotmail.com
           prasima25@gmail.com

Module Summary

Given the anatomic boundary between the fields of neurosurgery and otolaryngology, skull base surgery is always a challenge for both disciplines. The skull can be described as having two components: the neurocranium (braincase) and splanchnocranium (viscerocranium). The neurocranium in turn has two components, viz. calvarium (skull cap) and basicranium (skull base).

The anatomy of the two surfaces of basicranium, the endocranium and the exocranium, is difficult to comprehend. The endocranium can be divided further into three transverse parts (anterior, middle, and posterior fossae) and three sagittal parts (one central and two lateral parts). 

The module starts with the basic appraisal of the skull base anatomy. The illustrated references quoted here cover this difficult topic in a simplified way. The module then discusses the endoscopic anatomy of the skull base and various approach corridors for the skull base. 

The radiological correlations of different structures of the skull base can also be referred to further clarify the intricacies of the skull base.

Module Learning Objectives 
  1. Discuss the basic anatomy of the skull base.
  2. Visualise the intricate relations of the network of vessels and nerves at the skull base.
  3. Relate the radiological landmarks and structures of the skull base.
  4. Describe the various endoscopic approaches to the skull base.

 

Anatomy

Learning Objectives 
  1. Relate the basic anatomy of the skull base.
  2. Describe the foramina, triangles, neurovascular components, etc., of the skull base using simple line diagrams.
  3. Summarize the transnasal extracranial and intracranial skull base anatomy.          
  4. Visualize the endoscopic anatomy and approaches to the skull base.
References 
  1. Wanibuchi M, Friedman AH, Fukushima T. Photo Atlas of Skull Base Dissection: Techniques and Operative Approaches. New York: Thieme Medical Publishers, 2009. Chapters:  
    1. Craniofacial Anatomy: p.3-25
    2. Anatomy for Anterolateral Skull Base Surgery: p.109-121
    3. Anatomy for Lateral Skull Base Surgery: p.147-165
    4. Anatomy for Posterolateral Skull Base Surgery: p. 241-266 
    5. Anatomy for posterior skull base surgery p. 373-384
  2. Singh A, Wessell AP, Anand VK, Schwartz TH: Surgical anatomy and physiology for the skull base surgeon. Operative Techniques in Otolaryngology. 2011;22:184-193 
  3. Patel CR, Fernandez-Miranda JC, Wang WH, Wang EW: Skull Base Anatomy. Otolaryngol Clin N Am 49 (2016) 9–20 
  4. Schwartz TH, Anand VK. Endoscopic Skull Base and Pituitary Approaches – A Step-by-Step Guide for Surgical Instruction and Cadaveric Dissection. Tuttlingen, Germany: Endopress, 2014. p. 8-25
  5. Surgical Anatomy of the Skull Base. Available: https://neupsykey.com/surgical-anatomy-of-the-skull-base/
  6. Anatomy of the Skull Base and Related Structures: Elements of Surgical Anatomy. Available: https://neupsykey.com/anatomy-of-the-skull-base-and-related-structures-elements-of-surgical-anatomy/

 

Imaging

Learning Objectives 
  1. Trace the normal radiology of the skull base.
  2. Recognise and appreciate the intricate anatomical details demonstrated radiologically.

 

References 
  1. Glowniak JV, Alcantara AL, Getzen T, Dhawan A.: An interactive program for learning skull base anatomy. Department of Radiology, Wayne State University School of Medicine. Available: https://www2.med.wayne.edu/diagRadiology/Anatomy_Modules/axialpages/Home_Page.html
  2. Policeni BA, Smoker WRK: Imaging of the Skull Base Anatomy and Pathology. Radiol Clin N Am 53 (2015) 1–14 
  3. Skull Base CT anatomy. Available: http://www.headneckbrainspine.com/Skull-Base-CT.php

Review

Review Questions 
  1. Define the boundaries of the cranial fossae.
  2. Briefly describe the osteology of the cranial fossae.
  3. What are the various skull base triangles? 
  4. What is Perneczky’s pyramid?
  5. What structures occupy the cerebellopontine angle?
  6. Write up the contents of the cavernous sinus.

 

References 
  1. Anatomy of the Skull Base and Related Structures: Elements of Surgical Anatomy. Available: https://neupsykey.com/anatomy-of-the-skull-base-and-related-structures-elements-of-surgical-anatomy/
Resources 

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  1. Annual Meeting Webcast (AMW):