Surgeon's view of the skull base from the lateral approach

This paper presents the surgical anatomy of the skull base and infratemporal fossa. The information has been derived from the author's own experience in surgical and cadaver dissection, standard anatomical references, and selected experience of other skull base surgeons. Because the lateral approach has become the utilitarian method of exposure, the intricate detailed anatomy is demonstrated from this view at five levels of dissection, so the surgeon may gain a practical understanding of the surgical relationship of critical structures. Consistent anatomical landmarks can be used by the surgeon in the location of these critical structures. The styloid process, sphenoidal spine, and middle meningeal artery identify the internal carotid artery as it enters the carotid canal. The bony or fibrous septum that divides the jugular foramen into neural and vascular compartments may be used to better identify nerves IX, X, and XI. The zygomatic root is useful for location of the middle fossa dura. The lateral pterygoid plate leads directly to the foramen ovale. The increased precision of dissection permitted by use of the microscope requires an increased level of knowledge of anatomical structures in this area. It is hoped that the information presented in this paper will assist surgeons in the meticulous and thorough removal of skull base tumors and in the preservation of neural and vascular structures that are presently being sacrificed.