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Microsurgical Anatomy of the Cranial Base

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Principles of Neuro-Oncology

Abstract

The skull base represents one of most complex anatomical structures in the human body; as such, it has been the subject of significant anatomical and clinical research and discussion for centuries. The skull base consists of both an intracranial surface, which is related to the brain, and an extracranial or craniofacial surface, which is related to the nasal cavity sinuses, orbits, infra-temporal and pterygopalatine fossae, and the parapharyngeal and infrapetrosal spaces. In addition, the osseous segment (skull) is divided into the cranium and the facial skeleton. The cranium is further subdivided into the calvarium and the cranial base. In this chapter, through cadaveric anatomy, we will particularly focus on developing a comprehensive 360-degree perspective of the skull base, integrating the intracranial (dorsal) and extracranial (ventral) views.

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References

  1. Rhoton AJ. Cranial anatomy and surgical approaches. Philadephia: Lippincott Wiliams & Wilkins; 2003.

    Google Scholar 

  2. Kassam AB, Rovin RA, Walia S, Chakravarthi S, Celix J, Jennings J, Khalili S, Gonen L, Monroy-Sosa A, Fukui MB. The operating room of the future versus the future of the operating room. Otolaryngol Clin N Am. 2017;50(3):655–71. https://doi.org/10.1016/j.otc.2017.01.016.

    Article  Google Scholar 

  3. Gonen L, Chakravarthi SS, Monroy-Sosa A, Celix JM, Kojis N, Singh M, Jennings J, Fukui MB, Rovin RA, Kassam AB. Initial experience with a robotically operated video optical telescopic-microscope in cranial neurosurgery: feasibility, safety, and clinical applications. Neurosurg Focus. 2017;42(5):E9. https://doi.org/10.3171/2017.3.FOCUS1712.

    Article  PubMed  Google Scholar 

  4. Chakravarthi S, Monroy-Sosa A, Gonen L, Fukui M, Rovin R, Kojis N, Lindsay M, Khalili S, Celix J, Corsten M, Kassam AB. Reanalyzing the “far medial” (transcondylar-transtubercular) approach based on three anatomical vectors: the ventral posterolateral corridor. J Neurosurg Sci. 2018;62(3):347–55. https://doi.org/10.23736/S0390-5616.18.04356-4.

    Article  PubMed  Google Scholar 

  5. Rhoton AL Jr. The anterior and middle cranial base. Neurosurgery. 2002;51(4 Suppl):S273–302.

    PubMed  Google Scholar 

  6. Martins C, Costa ESIE, Campero A, Yasuda A, Aguiar LR, Tatagiba M, Rhoton A Jr. Microsurgical anatomy of the orbit: the rule of seven. Anat Res Int. 2011;2011:468727–14. https://doi.org/10.1155/2011/468727.

    Article  PubMed  Google Scholar 

  7. Rhoton AL Jr. The orbit. Neurosurgery. 2002;51(4 Suppl):S303–34.

    PubMed  Google Scholar 

  8. Tanriover N, Sanus GZ, Ulu MO, Tanriverdi T, Akar Z, Rubino PA, Rhoton AL Jr. Middle fossa approach: microsurgical anatomy and surgical technique from the neurosurgical perspective. Surg Neurol. 2009;71(5):586–96; discussion 596. https://doi.org/10.1016/j.surneu.2008.04.009.

    Article  PubMed  Google Scholar 

  9. Rhoton AL Jr. The sellar region. Neurosurgery. 2002;51(4 Suppl):S335–74.

    PubMed  Google Scholar 

  10. Natori Y, Rhoton AL Jr. Microsurgical anatomy of the superior orbital fissure. Neurosurgery. 1995;36(4):762–75. https://doi.org/10.1227/00006123-199504000-00018.

    Article  CAS  PubMed  Google Scholar 

  11. Rhoton AL Jr. The cavernous sinus, the cavernous venous plexus, and the carotid collar. Neurosurgery. 2002;51(4 Suppl):S375–410.

    PubMed  Google Scholar 

  12. Rhoton AL Jr. The temporal bone and transtemporal approaches. Neurosurgery. 2000;47(3 Suppl):S211–65. https://doi.org/10.1097/00006123-200009001-00023.

    Article  PubMed  Google Scholar 

  13. Rhoton AL Jr. The cerebellopontine angle and posterior fossa cranial nerves by the retrosigmoid approach. Neurosurgery. 2000;47(3 Suppl):S93–129. https://doi.org/10.1097/00006123-200009001-00013.

    Article  PubMed  Google Scholar 

  14. Monroy-Sosa A, Mendoza-Falcon G, Macias-Duvignau MA, Reyes-Soto G, Cardenas-Garcia Y, Mendizabal-Guerra R, Rhoton AL Jr. Neurosurgical importance of the superior petrosal venous complex. Neurocirugia (Astur). 2013;24(2):70–7. https://doi.org/10.1016/j.neucir.2012.09.004.

    Article  Google Scholar 

  15. Rhoton AL Jr. Jugular foramen. Neurosurgery. 2000;47(3 Suppl):S267–85. https://doi.org/10.1097/00006123-200009001-00026.

    Article  PubMed  Google Scholar 

  16. Rhoton AL Jr. The foramen magnum. Neurosurgery. 2000;47(3 Suppl):S155–93. https://doi.org/10.1097/00006123-200009001-00017.

    Article  PubMed  Google Scholar 

  17. de Oliveira E, Rhoton AL Jr, Peace D. Microsurgical anatomy of the region of the foramen magnum. Surg Neurol. 1985;24(3):293–352. https://doi.org/10.1016/0090-3019(85)90042-4.

    Article  PubMed  Google Scholar 

  18. Matsuno H, Rhoton AL Jr, Peace D. Microsurgical anatomy of the posterior fossa cisterns. Neurosurgery. 1988;23(1):58–80. https://doi.org/10.1227/00006123-198807000-00012.

    Article  CAS  PubMed  Google Scholar 

  19. de Divitiis O, d'Avella E, de Notaris M, Di Somma A, De Rosa A, Solari D, Cappabianca P. The (R)evolution of anatomy. World Neurosurg. 2019;127:710–35. https://doi.org/10.1016/j.wneu.2019.03.050.

    Article  PubMed  Google Scholar 

  20. Solari D, Chiaramonte C, Di Somma A, Dell'Aversana Orabona G, de Notaris M, Angileri FF, Cavallo LM, Montagnani S, Tschabitscher M, Cappabianca P. Endoscopic anatomy of the skull base explored through the nose. World Neurosurg. 2014;82(6 Suppl):S164–70. https://doi.org/10.1016/j.wneu.2014.08.005.

    Article  PubMed  Google Scholar 

  21. Peris-Celda M, Kucukyuruk B, Monroy-Sosa A, Funaki T, Valentine R, Rhoton AL, Jr. (2013) The recesses of the sellar wall of the sphenoid sinus and their intracranial relationships. Neurosurgery 73(2 Suppl operative):ons117–131. https://doi.org/10.1227/NEU.0000000000000184. discussion ons131

  22. Patel CR, Fernandez-Miranda JC, Wang WH, Wang EW. Skull Base Anatomy. Otolaryngol Clin N Am. 2016;49(1):9–20. https://doi.org/10.1016/j.otc.2015.09.001.

    Article  Google Scholar 

  23. Labib MA, Prevedello DM, Carrau R, Kerr EE, Naudy C, Abou Al-Shaar H, Corsten M, Kassam A. A road map to the internal carotid artery in expanded endoscopic endonasal approaches to the ventral cranial base. Neurosurgery. 2014;10(Suppl 3):448–71.; discussion 471. https://doi.org/10.1227/NEU.0000000000000362.

    Article  PubMed  Google Scholar 

  24. Dolci RLL, Ditzel Filho LFS, Goulart CR, Upadhyay S, Buohliqah L, Lazarini PR, Prevedello DM, Carrau RL. Anatomical nuances of the internal carotid artery in relation to the quadrangular space. J Neurosurg. 2018;128(1):174–81. https://doi.org/10.3171/2016.10.JNS16381.

    Article  PubMed  Google Scholar 

  25. Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL. Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the Sella turcica. Neurosurg Focus. 2005;19(1):E3.

    PubMed  Google Scholar 

  26. Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL. Expanded endonasal approach: the rostrocaudal axis. Part II. Posterior clinoids to the foramen magnum. Neurosurg Focus. 2005;19(1):E4.

    PubMed  Google Scholar 

  27. Funaki T, Matsushima T, Peris-Celda M, Valentine RJ, Joo W, Rhoton AL, Jr. (2013) Focal transnasal approach to the upper, middle, and lower clivus. Neurosurgery 73(2 Suppl operative):ons155–190. https://doi.org/10.1227/01.neu.0000431469.82215.93. discussion ons190–151

  28. Seker A, Inoue K, Osawa S, Akakin A, Kilic T, Rhoton AL Jr. Comparison of endoscopic transnasal and transoral approaches to the craniovertebral junction. World Neurosurg. 2010;74(6):583–602. https://doi.org/10.1016/j.wneu.2010.06.033.

    Article  PubMed  Google Scholar 

  29. Kassam AB, Snyderman C, Gardner P, Carrau R, Spiro R (2005) The expanded endonasal approach: a fully endoscopic transnasal approach and resection of the odontoid process: technical case report. Neurosurgery 57(1 Suppl):E213. https://doi.org/10.1227/01.neu.0000163687.64774.e4. discussion E213

  30. Kassam AB, Prevedello DM, Carrau RL, Snyderman CH, Gardner P, Osawa S, Seker A, Rhoton AL, Jr. (2009) The front door to meckel’s cave: an anteromedial corridor via expanded endoscopic endonasal approach- technical considerations and clinical series. Neurosurgery 64(3 Suppl):ons71–82. https://doi.org/10.1227/01.NEU.0000335162.36862.54. discussion ons82–73

  31. Dolci RL, Ditzel Filho LF, Goulart CR, Upadhyay S, Buohliqah L, Lazarini PR, Prevedello DM, Carrau RL. Anatomical nuances of the internal carotid artery in relation to the quadrangular space. J Neurosurg. 2017;128:1–8. https://doi.org/10.3171/2016.10.JNS16381.

    Article  Google Scholar 

  32. Dolci RL, Upadhyay S, Ditzel Filho LF, Fiore ME, Buohliqah L, Lazarini PR, Prevedello DM, Carrau RL. Endoscopic endonasal study of the cavernous sinus and quadrangular space: anatomic relationships. Head Neck. 2016;38(Suppl 1):E1680–7. https://doi.org/10.1002/hed.24301.

    Article  PubMed  Google Scholar 

  33. Rivera-Serrano CM, Terre-Falcon R, Fernandez-Miranda J, Prevedello D, Snyderman CH, Gardner P, Kassam A, Carrau RL. Endoscopic endonasal dissection of the pterygopalatine fossa, infratemporal fossa, and post-styloid compartment. Anatomical relationships and importance of eustachian tube in the endoscopic skull base surgery. Laryngoscope. 2010;120(Suppl 4):S244. https://doi.org/10.1002/lary.21711.

    Article  PubMed  Google Scholar 

  34. Falcon RT, Rivera-Serrano CM, Miranda JF, Prevedello DM, Snyderman CH, Kassam AB, Carrau RL. Endoscopic endonasal dissection of the infratemporal fossa: anatomic relationships and importance of eustachian tube in the endoscopic skull base surgery. Laryngoscope. 2011;121(1):31–41. https://doi.org/10.1002/lary.21341.

    Article  PubMed  Google Scholar 

  35. Benet A, Prevedello DM, Carrau RL, Rincon-Torroella J, Fernandez-Miranda JC, Prats-Galino A, Kassam AB. Comparative analysis of the transcranial “far lateral” and endoscopic endonasal “far medial” approaches: surgical anatomy and clinical illustration. World Neurosurg. 2014;81(2):385–96. https://doi.org/10.1016/j.wneu.2013.01.091.

    Article  PubMed  Google Scholar 

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Correspondence to Alejandro Monroy-Sosa .

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Monroy-Sosa, A., Chakravarthi, S.S., Epping, A., Kassam, A.B. (2021). Microsurgical Anatomy of the Cranial Base. In: Monroy-Sosa, A., Chakravarthi, S.S., de la Garza-Salazar, J.G., Meneses Garcia, A., Kassam, A.B. (eds) Principles of Neuro-Oncology. Springer, Cham. https://doi.org/10.1007/978-3-030-54879-7_7

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  • DOI: https://doi.org/10.1007/978-3-030-54879-7_7

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