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 thoroughly 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.