The intracranial surface of the anterior cranial base is formed by three different bones: frontal, ethmoid, and sphenoid ( 12). Spinal cord (medulla oblongata) spinal accessory nerves (CN XI) vertebral arteries anterior and posterior spinal arteries occipitoaxial ligament Lodges cartilaginous part of auditory (eustachian) tubeĬlosed inferiorly by a fibrocartilaginous plate that contains the auditory tube upper part traversed by the ICAįacial nerve (CN VII) stylomastoid arteryīeginning of the internal jugular vein cranial nerves IX, X, XIįacial nerve (CN VII) vestibuloacoustic nerve (CN VIII) Mandibular division of trigeminal nerve (CN V3) Maxillary division of trigeminal nerve (CN V2) Maxillary division of trigeminal nerve (CN V2) zygomatic branch of trigeminal nerve filaments from pterygopalatine branch of the maxillary nerve infraorbital vessels anastomosis between inferior ophthalmic vein and pterygoid venous plexus Occasional small vein origin of sagittal sinusĬranial nerves III, IV, ophthalmic division of trigeminal nerve (CN V1) superior ophthalmic vein TABLE 131.1 FORAMINA OF THE BASE OF THE SKULL The most effective scenario for the treatment of skull base pathologies occurs when members of these different fields are all integrated to form a skull base team. Contributions from skilled and experienced anesthesiologists, pathologists, critical care physicians, dentists, nurses, speech pathologists, physical therapists, and other professionals are required during the intraoperative and postoperative period in order to establish good outcomes. Frequently, the preoperative evaluation should include consultation with neuroradiology, radiation oncology, and medical oncology. The collaboration between surgeons of different specialties (otolaryngology/head and neck, neurosurgery, ophthalmology, plastic and reconstructive surgery) is paramount to achieve an appropriate surgical plan. The diversity and complexity of pathologies arising in the cranial base often require multidisciplinary evaluation and management. The cranial base is a complex anatomical region encompassing important neurovascular structures.
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