Skull Base and— Related Structures Atlas of Clinical Anatomy

Johannes Lang, Wurzburg

Foreword by M.Samii

Second Edition With 360 figures, mostly in color

Stuttgart Schattauer New York Contents Contents

Development 1 Development of the cerebral arteries 23 A. vertebralis 24 Persistent primitive cerebral arteries 25 Development of the skull base 1 Rarer variations 26 Some important cranial bones 3 A. ophthalmica 27 A. chorioidea anterior, rami chorioidei posteriores: Os sphenoidale 3 development 27 Rostrum sphenoidale 4 A. cerebri posterior 28 Canalis craniopharyngeus lateralis A. cerebri media 28 and canalis pterygoideus, posterior portion 4 A. cerebri anterior 28 Fossa hypophysialis 4 A. cerebelli inferior anterior 29 Canalis craniopharyngeus (medialis) 4 Concha sphenoidalis (ossicula Bertini) Circulus arteriosus cerebri and sinus sphenoidalis 4 (arterial circle of Willis) 29 Canalis opticus 5 Fetal development of the circle of Willis 30 Foramen ophthalmicum 5 Os temporale 5 Os occipitale 6 Os frontale and fossa anterior from outer aspect 9 Cerebral arterial circle Fossa cranii media 10 Fossa cranii posterior 10 in adults and aneurysms 31 Synchondroses sutures and their ossification 10 Synchondroses intrasphenoidales 10 Internal carotid artery 31 Synchondrosis sphenopetrosa 10 , Anterior communicating artery 31 Synchondrosis petrosphenobasilaris 10 Middle cerebral artery 31 Synchondrosis spheno-occipitalis 10 Posterior communicating artery 32 Synchondroses intraoccipitales 10 Posterior cerebral artery: precommunical segment .... 33 Malformations and their genesis n Cerebral arterial circle: medical implications 34 Blood distribution 34 Development of the brain n Muscle wall of the cerebral arteries and aneurysms ... 34 Rami centrales 34 Phylogenesis n Development and classification of aneurysms .... 36 Ontogenesis 11 Aneurysms and age 39 Somatotopical arrangement 12 Frequency of aneurysms 39 Brain vesicles 12 Size of aneurysms 39 Neuroporus rostralis (anterior) 12 Structure and wall structure 39 Neuroporus caudalis 12 Flexures 12 Aneurysms of the cerebral arteries: Form and parts of the brain 12 location in general 39 Differentiation of the vesicle walls 13 Aneurysms of the cerebral arteries: Development of the bulbus olfactorius 13 location in detail 39 The ; 15 Canalis caroticus 39 Ventriculus quartus and apertures 17 Sinus cavernosus 40 Synopsis of the developmental processes 19 Aneurysms at the origin of the arteria ophthalmica (extradural or subarachnoid location) 40 Aneurysms in the subarachnoid space 40 Development of the craniocervical Internal carotid artery, subarachnoid part 40 junction 19 Posterior communicating artery 41 Anterior choroidal artery 41 Carotid bifurcation 41 Defective closure of the skull and brain 20 Anterior cerebral artery and anterior communicating Development of myeloschisis 20 artery 41 Cephaloceles 21 Anterior cerebral artery, postcommunical part 42 Classification of cephaloceles 21 Middle cerebral artery, aneurysms 42 Arnold-Chiari syndrome ., 22 Vertebrobasilar system 44 Dandy-Walker syndrome 22 Rami retroolivares 44

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Very rare locations of aneurysms 45 Arachnoid membrane Traumatic aneurysms 45 and 67 Hypothalamus and vessels: Arachnoid membrane 67 aneurysms and hemorrhages 46 CSF spaces 67 Subarachnoid hematomas 46 Vascularized dural granulations in the 69 Surgical interventions for pain Cisterns 69 and emotional disorders 47 Subarachnoid cisterns and their medical Basic principles of Doppler sonography 49 significance 70 Subdural hematomas (bleeding into the subdural space) 71 Arachnoid cysts 72 Skull base and brain in children Brain and cranial nerves 72 Anatomical relationships and adults 51 between cranial nerves and cerebral vessels and their medical significance 73 Bones and portals 51 Nervi olfactorii 76 Inferior orbital fissure 54 Nervus opticus 79 Infratemporal fossa 55 N. oculomotorius 79 Pterygoid process and lamina pterygospinosa 55 N. trochlearis 82 Fissura sphenomaxillaris 57 N. trigeminus 84 Pterygopalatine fossa: walls and portals 57 N. abducens 85 Fissura petrotympanica 58 Nervus facialis (N. intermediofacialis) 87 Pars tympanica 58 N. intermedius 87 Processus styloideus and processus mastoideus ....:.. 58 N. vestibulocochlearis 89 Mandibular fossa, articular tubercle, N. glossopharyngeus 90 and articular eminence 58 N. vagus 90 Foramen stylomastoideum 59 N. accessorius 91 Processus mastoideus 59 N. hypoglossus 92 Inferior cranial base: portals for nerves Diagnostic techniques (Computer tomography, and vessels 60 NMR etc.) and approaches 93 Eustachian tube 60 Carotid canal 60 Foramen jugulare 61 Fossula petrosa and canaliculus tympanicus 61 Apertura externa canaliculi cochleae 61 Canaliculus mastoideus 62 Clinical anatomy of approaches 94 Hypoglossal canal 62 Foramen lacerum 62 Bifrontal and frontolateral approach 94 Upper wall of the nasal cavity and its channels .... 62 Osteology 96 Channels in the upper wall of the pharyngeal Levels of various sections 96 cavity 62 Diploic veins 98 Canalis vomerobasilaris 62 Postnatal growth 98 Canalis palatovaginalis 63 Paranasal sinuses 99 Canalis vomerovaginalis 63 99 Canalis craniopharyngeus medialis 63 Olfactory fossa 99 Canalis craniopharyngeus lateralis 63 Arachnoidea 100 Parts of the brain, veins, and arteries along Dura mater 63 the access route 103 Meningeal arteries 64 Brain 103 Frontal branch of the middle meningeal artery and Veins 105 its accompanying veins: structure within the skull 64 Arteries 105 Epidural aneurysms Rr. centrales, Aa. centrales anteromediales, (aneurysms of the dura mater) 65 Aa. thalamostriatae anteromediales 109 Epidural hematomas and intracranial pressure 67 Rr. diencephalici inferiores anteriores 109 Epidural hematomas 67 A. communicans anterior 110 Epidural hematomas and motor activity of the pupils Frontolateral access to the regio hypophysealis and eyes 67 and aneurysms in the anterior region Epidural hematomas and contralateral paresis of the circulus arteriosus 110 or paralysis 67 Compressions of the optic pathway Ill

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Middle cranial fossa 113 Clinoid processes 174 Deepest floor region 113 Variation of the sella turcica 174 Temporal fossa 113 Caroticoclinoid foramina 174 Thickest and thinnest floor zones Sellar spine 174 of the 113 Anterior surface of the petrous bone 174 Basal portals 114 Foramen lacerum 116 Cavernous sinus 177 Foramen petrosphenoideum anomalum 117 Cavernous sinus, definition 177 Pars petrosa ossis temporalis: rare variations 117 Petroclinoid folds, angles 177 Modelling of the floor 117 Diaphragmatic foramen, diameter 178 Hypophyseal cistern .„, 178 Pterional approach us Arteries 179 Soft tissue cover 119 Internal carotid artery, petrosal portion 179 Rami temporales of the facial nerve 123 Foramen lacerum internum 181 Temporal region, superficial vessels 124 Internal carotid artery in the cavernous sinus 181 Auriculotemporal nerve 126 Capsular arteries 182 Temporal muscle 126 Persistent trigeminal artery 182 Temporal fossa 128 Hypophysis 183 Pterional region of the skull 128 Lateral wall of the cavernous sinus Nerves 129 and nerves "in" the cavernous sinus 186 Skull 129 188 Veins in the middle cranial fossa 131 Maxillary nerve 189 Distance to the anterior petroclinoid fold and veins ... 137 Mandibular nerve 189 Basal vein (vein of Rosenthal) 137 189 Arteries in the vallecular cistern and the lateral 190 Cerebral cistern (Sylvian fissure) 139 Ganglia of the cavernous sinus 191 Middle cerebral artery: furcations and Inferior sphenopetrosal ligament 191 internal cerebral branches 139 Cavernous sinus, blood spaces Central branches 141 and connective tissue 191 Anterior cerebral artery and anterior communicating • Triangle of the cavernous sinus - anatomy 193 artery, approaches from laterally 142 Abducens nerve 194 Posterior cerebral artery, anterior choroidal artery Some syndromes 196 and posterior communicating artery 143 Superior orbital fissure syndrome 196 Pterional approach and bifurcation of the basilar Raeder's syndrome 196 artery 146 Cavernous sinus syndrome - anterior, middle, posterior 196 Subtemporal approach in general 147 Orbital apex syndrome 197 Soft tissue cover 147 Gradenigo's syndrome 197 Basal part of temporal lobe, sequence of gyri in the temporal approach 154 Special subtemporal approaches 198 Arteries 154 Subtemporal-transtemporal approach to the internal Posterior communicating artery, course 156 acoustic meatus and to the cerebellopontine angle ... 198 Point of origin and course of the twigs 156 Subtemporal-transtentorial approach Posterior communicating artery, nomenclature to the cerebellopontine angle 200 of the twigs 157 Apex partis petrosae, removal 201 We found 157 Aneurysms of the posterior cerebral artery and Posterior communicating artery and anterior saphenous vein bypass grafts, subtemporal approach . 203 choroidal artery, importance for aneurysms 163 Basilar artery: bifurcation area 164 Transsphenoidal approach Interpeduncular fossa 164 Arteries entering the posterior perforated substance . 164 to the hypophysis, clinical anatomy 204 Pharyngeal hypophysis and cysts of the roof Nomenclature of the arteries entering of the pharynx 207 the interpeduncular fossa 165 A. laminae tecti and ramus chorioideus posterior medialis 167 Supra- and infratentorial approaches 207 Interpeduncular fossa and bifurcation of the basilar Skull 207 artery, access 169 Dura mater 210 Cerebral veins and supra- and infratentorial Hypophyseal region 172 approach to the cisterna venae magnae Anatomy of the sella 172 (Galeni) 211 Osteology .j. 172 Bridging veins 213

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Bridging veins over the superolateral aspect Syndromes resulting from cranial nerve of the brain 214 lesions 270 Venae centrales superficiales mediales 215 Venae parietales superficiales.mediales 215 Craniocervical junction and approaches .... 270 Venae occipitales superficiales superiores mediales .. 216 Venae dorsales corporis callosi Soft tissues 272 and venae occipitales internae 216 Pars atlantica of the vertebral artery 277 Venae hemispherii inferiores 219 Pars atlantica, lateral approach 278 Bridging veins at the 219 Dorsal suboccipital approach 278 Bridging veins at the surface Posterolateral approach 281 of the and tentorial sinuses 219 Anterolateral approach 282 Paracavernous sinuses 222 Transoral-transnasal approach to the clivus and the Inferior anastomotic vein (Labbe) 224 upper cervical spine and its environment 283 Supratentorial approach, adjacent parts Primitive arteries of the region 284 of the brain 224 A. intersegmentalis proatlantica with bilateral Arteries encountered in the supratentorial absence of the vertebral artery 286 approach 225 Vertebrobasilar insufficiency 288 Tentorium cerebelli: nerves and opisthotonus 227 Some details concerning the medullae Infratentorial approach 228 oblongata and spinalis 289 Supra-infratentorial veins 230 Medullae oblongata and spinalis 289 Dorsal and ventral roots of Cl 290 Incisura tentorii and mesencephalon 234 Anastomoses 290 Parts of the mesencephalon 237 Ganglia 290 Pedunculus cerebri 237 Penetration of dura by Cl 291 Some syndromes resulting from lesions of the j Dorsal root of C2 291 tentorial notch and adjacent brain structures .... 238 Accessory nerve 292 Benedikt's syndrome 238 Ventral roots 293 Weber's syndrome 238 Hypoglossal nerve 293 Parinaud's syndrome 239 Tracts of the 294 Pyramidal decussation 297 Retrosigmoidal approach: anatomy 239 Emissary veins 246 Bones and articulations 298 Cerebellopontine angle (CPA) and petroclival Atlas 299 region and approaches 246 Axis 300 Brain parts and nerves 251 Anterior surface of the axis 301 Transtentorial approach accompanied Transverse ligament of the atlas 303 by supra- and infratemporal approaches Alar ligaments 303 to the basilar artery 253 Anterior and posterior longitudinal ligaments 303 Variations 305 Transpetrosal approach 256 Third condyle 305 Transsphenoidal approach 256 Odontoid bones 305 Transoral, transnasal approach to the clivus 257 Assimilation of the atlas 306 Arteries 258 Paracondylar process - pneumatic process - Basilar artery, branches ...._ 259 paramastoid process 306 Basilar artery, branches and aneurysms 259 Basilar impression 306 Pontine rami 259 A. cerebelli inferior anterior (AICA) 259 Posterior inferior cerebellar artery arising Infracranial spaces, muscles, vessels from the basilar artery 261 and nerves 308 Superior cerebellar artery 262 Temporal fascia 309 Basilar artery, terminal branching 262 Lateral pterygoid fascia 309 Pterygospinose ligament (interpterygoid fascia) 309 Jugular foramen 263 Temperobuccinator band 309 Stylopharyngeal fascia 310 Bony structures 263 Sphenopharyngeal (salpingopharyngeal, Shape 264 sphenopterygopharyngeal) fascia 310 Dura mater 264 Lamina profunda fasciae cervicalis 310 Cranial nerves IX-XI and jugular foramen 265 Pharyngeal fascia 310 Arteries 266 Spaces 310 Sinuses and nerves , 267 Spatium masticatorium 310 Dural portals for cranial nerved IX-XI 269 Salpingopharyngeal space 311

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Vagina carotica ....; 311 Vagus nerve 315 Spatium parapharyngeum 311 Accessory nerve 316 Prevertebral lamina and sympathetic trunk 311 Hypoglossal nerve 316 Infratemporal fossa: masticatory space, Hypogiossai-faciai anastomoses 317 vessels, and nerves 312 Arteria maxillaris, origin 312 Maxillary artery 312 References 319 Nerves in the masticatory space 313 Parapharyngeal space: nerves 314 Glossopharyngeal nerve 314 Subject 335