Skull base approaches

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Skull base approaches

  • cranial base is classically divided into anterior, middle, and posterior segments.

  • middle cranial base may be further subdivided into a single central and two lateral compartments. These compartments may be distinguished when viewing the skull base from extracranially if two imaginary parasagittal straight lines are drawn, one on each side, through the medial pterygoid plate anteriorly and the occipital condyle posteriorly. The central compartment lies medial to the two lines and the lateral compartments lateral to them.

  • Structures contained within the central compartment include the sella turcica, lower sphenoid sinus and rostrum, nasopharynx, pterygopalatine fossa, and lower clivus. Structures within the lateral compartments include the infratemporal fossa, parapharyngeal space, and petrous portion of the temporal bone.

Spaces of the base of skull

  • Parapharyngeal space

    • potential space lateral to the upper pharynx.

    • shaped like an inverted pyramid, extending from the skull base superiorly to the greater horn of the hyoid bone inferiorly.

    • fascia from the styloid process to the tensor veli palatini divides the PPS into an anterolateral compartment (ie, prestyloid) and a posteromedial (ie, poststyloid) compartment.

    • The prestyloid compartment contains the retromandibular portion of the deep lobe of the parotid gland, adipose tissue, and lymph nodes associated with the parotid gland.

    • The poststyloid compartment contains the internal carotid artery, the internal jugular vein, CNs IX- XII, the sympathetic chain, and lymph nodes.

  • Retropharyngeal space

      1. Anterior - Buccopharyngeal fascia which surrounds the pharynx, trachea, esophagus, and thyroid

      2. Posteriorly - alar fascia

      3. Laterally by the carotid sheaths and parapharyngeal spaces. It extends superiorly to the base of the skull and inferiorly to the mediastinum at the level of the tracheal bifurcation

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