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Surgical Anatomy of Skull Base

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

  2. Topography of Skull Base Boundaries : Anterior : Incisors upper teeth Posterior: Superior nuchal line Lateral : Upper lateral teeth Zygomatic arch Mastoid process www.nayyarENT.com

  3. Topography of Skull Base Anterior Skull Base Central Skull Base Posterior Skull Base www.nayyarENT.com

  4. 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 www.nayyarENT.com

  5. 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 www.nayyarENT.com

  6. 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 www.nayyarENT.com

  7. 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 www.nayyarENT.com

  8. 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) www.nayyarENT.com

  9. 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 www.nayyarENT.com

  10. Central Skull Base www.nayyarENT.com

  11. Central Skull Base 6 1 1 2 5 3 4 4- Auditory Area5- Articular Area6- Infratemporal Foss 1- Pharyngeal Area2- Tubal Area3- Neurovascular Area www.nayyarENT.com

  12. Pharyngeal Area Roof of Nasopharynx Boundaries of Nasopharynx : * Anterior * Lateral & Posterior * Inferior www.nayyarENT.com

  13. 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 www.nayyarENT.com

  14. Tubal Area Eustachian Tube Scaphoid fossa Runs b/w petrous bone & greater wing sphenoid Opening- nasopharynx Paratubal muscles www.nayyarENT.com

  15. Neurovascular Area Important structures are: Carotid sheath & its contents Styloid apparatus Facial Nerve www.nayyarENT.com

  16. 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 www.nayyarENT.com

  17. Jugular Foramen Divided into three compartments www.nayyarENT.com

  18. Styloid Apparatus Bone- Styloid bone Ligaments- * Stylohyoid * Stylomandibular Muscles- * Stylohoid * Stylopharyngeus * Styloglossus www.nayyarENT.com

  19. Facial Nerve Arise from Stylomastoid Foramen Branches: i) Post auricular nerve ii) Digastric branch iii) Temporofacial branch iv) Cervicofacial branch www.nayyarENT.com

  20. Auditory Area Petrotympanic fissure of Glaser: * Chorda tympani * Ant br of tympanic artery www.nayyarENT.com

  21. Infratemporal Fossa Location : below middle cranial fossa Boundaries Contents: * Med & Lat Pterygoid M * Maxillary A * Maxillary V * Pterygoid Venous Plexus * Br of Mandibular N www.nayyarENT.com

  22. Pterygopalatine Fossa Small inverted pyramid shaped fossa Location Boundaries Communications www.nayyarENT.com

  23. Anterior Cranial Base www.nayyarENT.com

  24. Anterior Cranial Base from inside www.nayyarENT.com

  25. Floor of Anterior Cranial Fossa • Depth of Olfactory fossa (Keros classification) * Type I – 1-3mm * Type II- 4-7mm * Type III- 8-17mm www.nayyarENT.com

  26. Thank youFor more presentations, visit www.nayyarENT.com www.nayyarENT.com

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