oneurosurgical Anatomy and Surgical Technique -- Xiang'En Shi, Long Wang, Hai Qian, (eds_) -- Springer Nature, Singapore, 2023 -- SPRINGER VERLAG, -- isbn13 9789811982729 -- ef5fc3c54d6dbd5926fa2299ab06a86c -- Anna’s A - PDF to Podcast
Published on Sep 22, 2026
Description:
Welcome to Skull Base Fundamentals, the show where we walk through surgical anatomy one landmark at a time. I'm Sam Okafor.I'm joined by Dr. Renata Silva. Renata, this chapter opens with what looks like a directory of bony landmarks. The anterior view alone names the supraorbital foramen, the glabella, the nasion, the optic foramen, and the superior and inferior orbital fissures. Why begin there?
Because that is the vocabulary you need before anything else in the chapter makes sense. The anterior view of the cranium maps the supraorbital foramen and notch, the glabella, the superciliary arch, the supraorbital margin, the frontonasal suture, the nasion, the optic foramen, the superior and inferior orbital fissures, the vomer, the inferior nasal concha, the infraorbital foramen, the zygomatic bone, and the maxilla.The lateral view then adds the sutures and the surgical landmarks: the coronal suture, the superior and inferior temporal lines, the squamosal suture, the frontal process of the zygomatic bone, the mastoid process, the styloid process, the external acoustic meatus, the zygomatic arch, and the pterion.
Now take us to the base of the skull. That is where the anatomy gets dense.
From the outside, yes. The external view of the anterior and middle cranial base shows the maxilla, the palatine bone, the vomer, the medial and lateral pterygoid plates, the inferior orbital fissure, the clivus, the foramen lacerum, the foramen ovale and the foramen spinosum, the mandibular fossa, the styloid process, the stylomastoid foramen, the external opening of the carotid canal, the occipital condyle, and the infratemporal fossa.The view of the middle and posterior fossae from below adds the digastric groove, the occipital groove, the jugular process, the jugular foramen, the posterior condylar canal, the petrous apex, and the foramen magnum with its anterior and posterior margins.And the internal view of the skull base gives you the cribriform plate, the crista galli, the planum sphenoidale, the chiasmatic sulcus, the pituitary fossa, the dorsum sellae and the clivus, the three cranial fossae, the optic canal, the foramen rotundum, the internal acoustic meatus, the hypoglossal canal, the arcuate eminence, the tegmen tympani, the transverse and sigmoid sulci, and the petrous ridge.
Hearing it read out like that, what strikes me is how many critical structures — the optic canal, the carotid canal, the jugular foramen, the hypoglossal canal — are packed into that one region of the skull base.What about the dura? What does the chapter show there?
The lateral view of cranial dura mater shows the frontal, parietal, and parieto-occipital branches of the middle meningeal artery, the posterior meningeal artery, and the transverse sinus.The superior view of convexity dura then shows the frontal sinus, the superior sagittal sinus, the lateral lacunae, the middle meningeal veins, and the middle meningeal artery — arterial and venous anatomy sitting in the same corridor.
Then the brain surface itself. Where do they start?
Laterally: the superior sagittal sinus and superior cerebral veins, the superior, middle, and inferior frontal gyri, the precentral and postcentral gyri, the supramarginal and angular gyri, the inferior and superior parietal lobules, the occipital lobe, and the superior, middle, and inferior temporal gyri.That same lateral view names the pars orbitalis, pars triangularis, and pars opercularis, the Sylvian vein — that is the superficial middle cerebral vein — and the superior and inferior anastomotic veins, the veins of Trolard and Labbé, along with the central sulcus and the postcentral sulcus.
And the medial and inferior surfaces?
Medially you get the gyrus rectus, the inferior and superior rostral gyri, the cingulate sulcus and cingulate gyrus, the callosal sulcus, the paracentral lobule, the precuneus, the cuneus, the calcarine sulcus, the lingual, fusiform, and parahippocampal gyri, the uncus, and the genu, body, and splenium of the corpus callosum.Inferiorly the chapter adds the olfactory tract and olfactory trigone, the orbital gyri, the optic nerve and optic tract, the infundibulum, the mammillary bodies, the oculomotor nerve, the cerebral peduncle, the substantia nigra, the superior colliculus, and the lateral geniculate body.
Now the operation itself. The chapter walks through the interhemispheric transcallosal approach.
The craniotomy for it exposes the coronal suture, the middle and superior frontal gyri, the superior sagittal sinus, the posterior frontal vein, and the longitudinal fissure.Then the trajectory: the superior sagittal sinus, the left and right pericallosal arteries, the right callosomarginal artery, the falx cerebri, the right callosal sulcus, the cingulate gyrus, the inferior sagittal sinus, and the body of the corpus callosum.
And then the callostomy?
The callostomy brings the third ventricle into view, along with the superior sagittal sinus, the left and right pericallosal arteries, the right medial intermediate frontal artery, and the right callosal sulcus.
The chapter closes with two cases. Take the first one.
A 12-year-old boy with a three-year history of a frontal mass. His neurological exam was uneventful.Pre-operative CT revealed a well-defined, uncalcified, hypodense mass eroding the outer table of the frontal bone, and T1-weighted MRI showed an osseous round lesion expanding into subcutaneous tissue and invading the inner table.A curvilinear incision was made along the outer margin of the osseous mass. After the subcutaneous tissue was opened, the nodule protruded from the bony surface with a ductile texture, and the lesion with outer table erosion was resected en bloc while the inner table of the frontal bone remained well defined.When the mass was opened, the lipid component was seen with hair — and the chapter's diagnosis is a frontal epidermoid cyst.
And the second case?
A 39-year-old woman with a four-day history of headache and hemiparesis. On neurological exam, muscle strength was grade IV in the left lower extremity and grade V elsewhere.Gd-enhanced T1-weighted MRI delineated a well-circumscribed frontoparietal lesion that was enhanced heterogeneously, with mass effect pushing the falx to the contralateral side and a dural tail.CT in bone window showed hyperostosis of the overlying calvarium. The patient was placed supine, the skin flap was retracted to the midline, and the sagittal and coronal sutures were exposed. The diagnosis was a right frontoparietal meningioma.
Two things stay with me. First, those cases read like the anatomy list set in motion — every named foramen and every sinus turns into a decision.
That is the chapter's own framing: the cranial, dural, and brain surface anatomy is presented as the groundwork for the surgical techniques, and the two cases are there to show the groundwork being applied.
That is our tour — cranium, dura mater, brain surface, and two operations. Thanks for joining us.
Thanks, Sam. And to everyone listening — next time, we go back to the map.