Search tips
Search criteria 


Logo of skullbasesurgInstructions for AuthorsSubscribe to Skull BaseAbout Skull BaseEditorial BoardThieme Medical PublishingSkull Base An Interdisciplinary Approach ...
Skull base surgery. 1998; 8(3): 105–117.
PMCID: PMC1656675

Anatomo-Radiological Evaluation of Lateral Approaches to the Skull Base


Our objective is to correlate the anatomical exposure provided by complex skull base approaches to the lateral skull base with their CT and MRI scans counterparts and to introduce a modular concept emphasizing the derivation of complex skull base approaches from simpler ones.

We executed 10 lateral approaches to the skull base in 20 embalmed cadaveric heads (40 sides). Each approach was executed a minimum of three times on each specimen. These approaches were the pterional and its modifications, the subtemporal and its modifications, and the suboccipital and its modifications. We correlated the approaches and the areas of the skull base exposed by scanning the surgical cavity filled with material imageable by CT and MRI and throughly surveying the operative field.

Visualization of the area of the skull base exposed was excellent using our CT-MRI imageable cadaveric preparation. The topographic areas of the skull base exposed correlated well with their radiological counterparts.

The areas of the skull base exposed by each of the complex surgical approaches to the skull base were clearly delineated by using our anatomo-radiological correlation. Complex approaches to the skull base are formed by simple neurosurgical approaches (building blocks) to which different modules are added.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (6.4M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Al-Mefty O. Supraorbital-pterional approach to skull base lesions. Neurosurgery. 1987 Oct;21(4):474–477. [PubMed]
  • Al-Mefty O, Fox JL, Smith RR. Petrosal approach for petroclival meningiomas. Neurosurgery. 1988 Mar;22(3):510–517. [PubMed]
  • Ammirati M, Ma J, Canalis R, Martin N, Black K, Cheatham M, Bloch J, Becker D. A combined intradural presigmoid-transtransversarium-transcondylar approach to the whole clivus and anterior craniospinal region: anatomic study. Skull Base Surg. 1993;3(4):193–200. [PMC free article] [PubMed]
  • Baldwin HZ, Miller CG, van Loveren HR, Keller JT, Daspit CP, Spetzler RF. The far lateral/combined supra- and infratentorial approach. A human cadaveric prosection model for routes of access to the petroclival region and ventral brain stem. J Neurosurg. 1994 Jul;81(1):60–68. [PubMed]
  • Couldwell WT, Fukushima T, Giannotta SL, Weiss MH. Petroclival meningiomas: surgical experience in 109 cases. J Neurosurg. 1996 Jan;84(1):20–28. [PubMed]
  • Day JD, Giannotta SL, Fukushima T. Extradural temporopolar approach to lesions of the upper basilar artery and infrachiasmatic region. J Neurosurg. 1994 Aug;81(2):230–235. [PubMed]
  • Fujitsu K, Kuwabara T. Orbitocraniobasal approach for anterior communicating artery aneurysms. Neurosurgery. 1986 Mar;18(3):367–369. [PubMed]
  • Hakuba A, Tanaka K, Suzuki T, Nishimura S. A combined orbitozygomatic infratemporal epidural and subdural approach for lesions involving the entire cavernous sinus. J Neurosurg. 1989 Nov;71(5 Pt 1):699–704. [PubMed]
  • Harsh GR, 4th, Sekhar LN. The subtemporal, transcavernous, anterior transpetrosal approach to the upper brain stem and clivus. J Neurosurg. 1992 Nov;77(5):709–717. [PubMed]
  • Kawase T, Shiobara R, Toya S. Anterior transpetrosal-transtentorial approach for sphenopetroclival meningiomas: surgical method and results in 10 patients. Neurosurgery. 1991 Jun;28(6):869–876. [PubMed]
  • Origitano TC, Anderson DE, Tarassoli Y, Reichman OH, al-Mefty O. Skull base approaches to complex cerebral aneurysms. Surg Neurol. 1993 Oct;40(4):339–346. [PubMed]
  • Sen CN, Sekhar LN. The subtemporal and preauricular infratemporal approach to intradural structures ventral to the brain stem. J Neurosurg. 1990 Sep;73(3):345–354. [PubMed]
  • Spetzler RF, Daspit CP, Pappas CT. The combined supra- and infratentorial approach for lesions of the petrous and clival regions: experience with 46 cases. J Neurosurg. 1992 Apr;76(4):588–599. [PubMed]
  • Tedeschi H, Rhoton AL., Jr Lateral approaches to the petroclival region. Surg Neurol. 1994 Mar;41(3):180–216. [PubMed]
  • Krayenbühl HA, Yaşargil MG, Flamm ES, Tew JM., Jr Microsurgical treatment of intracranial saccular aneurysms. J Neurosurg. 1972 Dec;37(6):678–686. [PubMed]
  • Yasargil MG, Antic J, Laciga R, Jain KK, Hodosh RM, Smith RD. Microsurgical pterional approach to aneurysms of the basilar bifurcation. Surg Neurol. 1976 Aug;6(2):83–91. [PubMed]
  • Yasargil MG, Fox JL. The microsurgical approach to intracranial aneurysms. Surg Neurol. 1975 Jan;3(1):7–14. [PubMed]
  • Dolenc VV, Skrap M, Sustersic J, Skrbec M, Morina A. A transcavernous-transsellar approach to the basilar tip aneurysms. Br J Neurosurg. 1987;1(2):251–259. [PubMed]
  • van Loveren HR, Keller JT, el-Kalliny M, Scodary DJ, Tew JM., Jr The Dolenc technique for cavernous sinus exploration (cadaveric prosection). Technical note. J Neurosurg. 1991 May;74(5):837–844. [PubMed]
  • al-Mefty O, Anand VK. Zygomatic approach to skull-base lesions. J Neurosurg. 1990 Nov;73(5):668–673. [PubMed]
  • Delashaw JB, Jr, Tedeschi H, Rhoton AL. Modified supraorbital craniotomy: technical note. Neurosurgery. 1992 Jun;30(6):954–956. [PubMed]
  • Fujitsu K, Kuwabara T. Zygomatic approach for lesions in the interpeduncular cistern. J Neurosurg. 1985 Mar;62(3):340–343. [PubMed]
  • Hakuba A, Liu S, Nishimura S. The orbitozygomatic infratemporal approach: a new surgical technique. Surg Neurol. 1986 Sep;26(3):271–276. [PubMed]
  • Ikeda K, Yamashita J, Hashimoto M, Futami K. Orbitozygomatic temporopolar approach for a high basilar tip aneurysm associated with a short intracranial internal carotid artery: a new surgical approach. Neurosurgery. 1991 Jan;28(1):105–110. [PubMed]
  • Jane JA, Park TS, Pobereskin LH, Winn HR, Butler AB. The supraorbital approach: technical note. Neurosurgery. 1982 Oct;11(4):537–542. [PubMed]
  • Neil-Dwyer G, Sharr M, Haskell R, Currie D, Hosseini M. Zygomaticotemporal approach to the basis cranii and basilar artery. Neurosurgery. 1988 Jul;23(1):20–22. [PubMed]
  • Pellerin P, Lesoin F, Dhellemmes P, Donazzan M, Jomin M. Usefulness of the orbitofrontomalar approach associated with bone reconstruction for frontotemporosphenoid meningiomas. Neurosurgery. 1984 Nov;15(5):715–718. [PubMed]
  • Pitelli SD, Almeida GG, Nakagawa EJ, Marchese AJ, Cabral ND. Basilar aneurysm surgery: the subtemporal approach with section of the zygomatic arch. Neurosurgery. 1986 Feb;18(2):125–128. [PubMed]
  • Sekhar LN, Kalia KK, Yonas H, Wright DC, Ching H. Cranial base approaches to intracranial aneurysms in the subarachnoid space. Neurosurgery. 1994 Sep;35(3):472–483. [PubMed]
  • Shiokawa Y, Saito I, Aoki N, Mizutani H. Zygomatic temporopolar approach for basilar artery aneurysms. Neurosurgery. 1989 Nov;25(5):793–797. [PubMed]
  • DRAKE CG. Bleeding aneurysms of the basilar artery. Direct surgical management in four cases. J Neurosurg. 1961 Mar;18:230–238. [PubMed]
  • Drake CG. Surgical treatment of ruptured aneurysms of the basilar artery. Experience with 14 cases. J Neurosurg. 1965 Nov;23(5):457–473. [PubMed]
  • Drake CG. The surgical treatment of aneurysms of the basilar artery. J Neurosurg. 1968 Oct;29(4):436–446. [PubMed]
  • Drake CG. The surgical treatment of vertebral-basilar aneurysms. Clin Neurosurg. 1969;16:114–169. [PubMed]
  • Day JD, Fukushima T, Giannotta SL. Microanatomical study of the extradural middle fossa approach to the petroclival and posterior cavernous sinus region: description of the rhomboid construct. Neurosurgery. 1994 Jun;34(6):1009–1016. [PubMed]
  • House WF, Hitselberger WE, Horn KL. The middle fossa transpetrous approach to the anterior-superior cerebellopontine angle. Am J Otol. 1986 Jan;7(1):1–4. [PubMed]
  • Miller CG, van Loveren HR, Keller JT, Pensak M, el-Kalliny M, Tew JM., Jr Transpetrosal approach: surgical anatomy and technique. Neurosurgery. 1993 Sep;33(3):461–469. [PubMed]
  • Shiobara R, Ohira T, Kanzaki J, Toya S. A modified extended middle cranial fossa approach for acoustic nerve tumors. Results of 125 operations. J Neurosurg. 1988 Mar;68(3):358–365. [PubMed]
  • Taha JM, Tew JM, Jr, van Loveren HR, Keller JT, el-Kalliny M. Comparison of conventional and skull base surgical approaches for the excision of trigeminal neurinomas. J Neurosurg. 1995 May;82(5):719–725. [PubMed]
  • Kawase T, Toya S, Shiobara R, Mine T. Transpetrosal approach for aneurysms of the lower basilar artery. J Neurosurg. 1985 Dec;63(6):857–861. [PubMed]
  • Sekhar LN, Estonillo R. Transtemporal approach to the skull base: an anatomical study. Neurosurgery. 1986 Nov;19(5):799–808. [PubMed]
  • Sekhar LN, Pomeranz S, Janecka IP, Hirsch B, Ramasastry S. Temporal bone neoplasms: a report on 20 surgically treated cases. J Neurosurg. 1992 Apr;76(4):578–587. [PubMed]
  • Sekhar LN, Schramm VL, Jr, Jones NF. Subtemporal-preauricular infratemporal fossa approach to large lateral and posterior cranial base neoplasms. J Neurosurg. 1987 Oct;67(4):488–499. [PubMed]
  • Bricolo AP, Turazzi S, Talacchi A, Cristofori L. Microsurgical removal of petroclival meningiomas: a report of 33 patients. Neurosurgery. 1992 Nov;31(5):813–828. [PubMed]
  • Drake CG. Surgical treatment of acoustic neuroma with preservation or reconstitution of the facial nerve. J Neurosurg. 1967 May;26(5):459–464. [PubMed]
  • Morrison AW, King TT. Experiences with a translabyrinthine-transtentorial approach to the cerebellopontine angle. Technical note. J Neurosurg. 1973 Mar;38(3):382–390. [PubMed]
  • Samii M, Ammirati M. The combined supra-infratentorial pre-sigmoid sinus avenue to the petro-clival region. Surgical technique and clinical applications. Acta Neurochir (Wien) 1988;95(1-2):6–12. [PubMed]
  • Ammirati M, Ma J, Cheatham ML, Maxwell D, Bloch J, Becker DP. Drilling the posterior wall of the petrous pyramid: a microneurosurgical anatomical study. J Neurosurg. 1993 Mar;78(3):452–455. [PubMed]
  • Hakuba A, Nishimura S, Inoue Y. Transpetrosal-transtentorial approach and its application in the therapy of retrochiasmatic craniopharyngiomas. Surg Neurol. 1985 Oct;24(4):405–415. [PubMed]
  • Hakuba A, Nishimura S, Jang BJ. A combined retroauricular and preauricular transpetrosal-transtentorial approach to clivus meningiomas. Surg Neurol. 1988 Aug;30(2):108–116. [PubMed]
  • Sakaki S, Takeda S, Fujita H, Ohta S. An extended middle fossa approach combined with a suboccipital craniectomy to the base of the skull in the posterior fossa. Surg Neurol. 1987 Oct;28(4):245–252. [PubMed]
  • Samii M, Ammirati M, Mahran A, Bini W, Sepehrnia A. Surgery of petroclival meningiomas: report of 24 cases. Neurosurgery. 1989 Jan;24(1):12–17. [PubMed]
  • Sekhar LN, Swamy NK, Jaiswal V, Rubinstein E, Hirsch WE, Jr, Wright DC. Surgical excision of meningiomas involving the clivus: preoperative and intraoperative features as predictors of postoperative functional deterioration. J Neurosurg. 1994 Dec;81(6):860–868. [PubMed]
  • Heros RC. Lateral suboccipital approach for vertebral and vertebrobasilar artery lesions. J Neurosurg. 1986 Apr;64(4):559–562. [PubMed]
  • al-Mefty O, Borba LA, Aoki N, Angtuaco E, Pait TG. The transcondylar approach to extradural nonneoplastic lesions of the craniovertebral junction. J Neurosurg. 1996 Jan;84(1):1–6. [PubMed]
  • Babu RP, Sekhar LN, Wright DC. Extreme lateral transcondylar approach: technical improvements and lessons learned. J Neurosurg. 1994 Jul;81(1):49–59. [PubMed]

Articles from Skull Base Surgery are provided here courtesy of Thieme Medical Publishers