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ANATOMY OF CRANIAL BASE & 
NASAL CAVITIES. 
Endoscopic Endonasal Removal 
of Pituitary Tumors. 
MS: Milad Basim 
10/27/2014 1
CRANIAL CAVITY: 
The cranial cavity is the space within the cranium that contains the 
brain, meninges, proximal parts of the cranial nerves, blood vessels, 
and cranial venous sinuses. 
CRANIAL BASE (FLOOR): 
The skull base forms the floor of the cranial cavity and separates the 
brain from other facial structures. 
The 5 bones that make up the skull base are the 
 Ethmoid. 
 Sphenoid. 
 Occipital. 
 paired frontal. 
 paired temporal bones. 
10/27/2014 2
CRANIAL FOSSA: 
The cranial base is divided into the following three cranial fossae, 
with each having numerous foramina (openings) for structures to 
pass in or out of the neurocranium. 
 Anterior cranial fossa. 
 Middle cranial fossa. 
 Posterior cranial fossa. 
10/27/2014 3
Anterior cranial fossa: 
composes the roof of the orbits, and accommodates the frontal lobes 
of the brain (right and left). 
Formed by: 
• orbital plate of the frontal bone. 
• cribiform plate of ethmoid bone. 
• lesser wings of the sphenoid bone. 
Boundaries: 
• Anteriorly: posterior wall of frontal sinus 
• Posteriorly: roof of splenoid sinus 
• Laterally: frontal bone (paired, both sides) 
• Centrally: eithmoid bone 
10/27/2014 4
“Anterior cranial fossa and their structures” 
10/27/2014 5
Middle cranial fossa: 
accommodates the temporal lobes of the brain. 
The petro-occipital fissure subdivides the middle cranial fossa into 1 
central component and 2 lateral components. 
Boundaries: 
• Anteriorly: Greater wing of sphenoid bone. 
• Posteriorly: superior borders of petrous part of temporal. 
• Laterally: squamous part of temporal and some part if parietal 
and greater wings of sphenoid. 
• Centrally: sella tursica (or sella turcica) of body of sphenoid. 
10/27/2014 6
Middle cranial fossa and their structures 
10/27/2014 7
Posterior cranial fossa: 
accommodates the cerebellum, pons, and medulla oblongata of the 
brain (occipital lobes). 
Boundaries: 
• Anteriorly: superior border of the petrous part of temporal 
bone. 
• Posteriorly: lesser part of the occipital squamous. 
• Laterally: Temporal & parietal bone. 
• Floor: Occipital bone. 
• Centrally: Foramen magnum. 
The anterior cranial fossa is separated from the middle cranial fossa 
by the lesser wing of the sphenoid, and the middle cranial fossa is 
separated from the posterior cranial fossa by the petrous part of the 
temporal bone. 
10/27/2014 8
Posterior cranial fossa and their structures 
10/27/2014 9
NASAL CAVITIES: 
The nasal cavities extend from the anterior apertures (nares) to the 
posterior apertures (choanae). 
The nasal cavities are separated: 
• from each other by a midline nasal septum. 
• from the oral cavity below by the hard palate. 
• from the cranial cavity above by parts of the frontal, 
ethmoid, and sphenoid bones. 
Each nasal cavity has: 
 Floor. 
 roof. 
 medial wall. 
 lateral wall. 
10/27/2014 10
Nasal cavities (anterolateral view). 
10/27/2014 Relationship to other cavities. 11
Roof: 
Formed by: 
•Body of sphenoid. 
•Cribriform plate 
of ethmoid bone. 
•Frontal bone. 
•Nasal bone & cartilage. 
•vomer. 
10/27/2014 12
Floor: 
Formed by the hard palate (palatine process of the 
maxilla, and the horizontal plate of the palatine bone ) 
10/27/2014 13
Medial Wall (Nasal Septum): 
Formed by: 
• Superiorly 
by the vertical (perpendicular) 
plate of ethmoid bone. 
• Posteriorly 
by the vomer bone. 
• Anteriorly 
by the septal cartilage. 
• small contributions by 
frontal, palatine, sphenoid 
and maxillary bones. 
10/27/2014 14
Lateral wall: 
The lateral wall of each nasal cavity is complex and is formed by 
bone, cartilage, and soft tissues. 
Bony support for the lateral wall is provided by: 
 the ethmoidal labyrinth 
and uncinate process. 
 the perpendicular plate 
of the palatine bone. 
 the medial plate of the 
pterygoid process of the 
sphenoid bone. 
 the medial surfaces of the 
lacrimal bones and maxillae. 
 the inferior concha. 
10/27/2014 15
Lateral wall: 
The lateral wall is characterized by three curved shelves of bone 
(conchae), which are one above the other and project medially and 
inferiorly across the nasal cavity. 
The conchae divide each nasal cavity into four air channels: 
 an inferior nasal meatus between the inferior concha and the 
nasal floor. 
 a middle nasal meatus between the inferior and middle concha. 
 a superior nasal meatus between the middle and superior 
concha. 
 a spheno-ethmoidal recess between the superior concha and the 
nasal roof. 
10/27/2014 16
Floor, roof, and lateral walls. 
Conchae on lateral walls. 
10/27/2014 17
The superior and middle conchae are parts of the ethmoid 
bone, whereas the inferior concha is a separate bone. 
The conchae increase the surface area of the nasal cavity 
10/27/2014 18
The recess & meati receive the openings of the: 
Paranasal sinuses. 
Nasolacrimal duct. 
 Sphenoethmoidal recess: Receives the opening of the 
sphenoidal sinus. 
 Superior meatus: Receives the opening of the posterior 
ethmoidal sinus. 
 Inferior meatus: Receives the opening of the nasolacrimal 
duct. The opening is guarded by a valve, a fold of mucous 
membrane 
10/27/2014 19
Middle meatus: 
•Shows a rounded eminence, the ethmoidal bulla, caused by 
the bulging of the underlying middle ethmoidal sinus, 
which opens on its upper border. 
•A curved groove, hiatus semilunaris, lies below the bulla. 
Hiatus receives the opening of the maxillary sinus. 
•Anterior end of hiatus leads to funnel-shaped infundibulum, 
which receives the openings of the frontal & the anterior 
ethmoidal sinuses. 
10/27/2014 20
Paranasal sinuses and meatuses 
10/27/2014 21
Regions of the nasal cavities 
10/27/2014 22
Gateways to the nasal cavities 
10/27/2014 23
Blood Supply and Innervation 
10/27/2014 24
Endoscopic Endonasal Removal of Pituitary Tumors: 
The endoscopic endonasal transsphenoidal procedure is a new and 
minimally invasive approach for the resection of pituitary tumors. 
10/27/2014 25
Who is Dr. Moreland ? 
Dr. Moreland has pioneered this technique both locally and 
internationally. He has one of the largest series in the country 
utilizing this procedure. 
Benefits of endonasal endoscopic surgery: 
 Results in less pain and a faster recovery than traditional surgery. 
 Does not leave a visible scar on the face or scalp. 
 Allows the patient to start radiation therapy, if needed, almost 
immediately, without waiting for incisions to heal. 
10/27/2014 26
Procedure: 
The procedure involves passing a 4mm rigid endoscope into the 
nostril to provide illumination and visualization. No incision is made 
nor is it necessary to break the nose with this new technique. Both 
of these maneuvers are necessary with the older traditional 
approach and they are a great source of pain and longer hospital 
stays. The sphenoid sinus and pituitary fossa are then entered using 
microsurgical instruments. The anatomy as seen by the endoscope is 
projected onto a television monitor as the surgeon resects the 
tumor. 
10/27/2014 27
Sources: 
imueos.wordpress.com 
Gray’s anatomy book 
Nether’s clinical anatomy book 
www.hopkinsmedicine.org 
buffaloneuro.com 
From others presentations 
10/27/2014 28
Thank you for your 
attention 
10/27/2014 29

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cranial base and nasal cavity

  • 1. ANATOMY OF CRANIAL BASE & NASAL CAVITIES. Endoscopic Endonasal Removal of Pituitary Tumors. MS: Milad Basim 10/27/2014 1
  • 2. CRANIAL CAVITY: The cranial cavity is the space within the cranium that contains the brain, meninges, proximal parts of the cranial nerves, blood vessels, and cranial venous sinuses. CRANIAL BASE (FLOOR): The skull base forms the floor of the cranial cavity and separates the brain from other facial structures. The 5 bones that make up the skull base are the  Ethmoid.  Sphenoid.  Occipital.  paired frontal.  paired temporal bones. 10/27/2014 2
  • 3. CRANIAL FOSSA: The cranial base is divided into the following three cranial fossae, with each having numerous foramina (openings) for structures to pass in or out of the neurocranium.  Anterior cranial fossa.  Middle cranial fossa.  Posterior cranial fossa. 10/27/2014 3
  • 4. Anterior cranial fossa: composes the roof of the orbits, and accommodates the frontal lobes of the brain (right and left). Formed by: • orbital plate of the frontal bone. • cribiform plate of ethmoid bone. • lesser wings of the sphenoid bone. Boundaries: • Anteriorly: posterior wall of frontal sinus • Posteriorly: roof of splenoid sinus • Laterally: frontal bone (paired, both sides) • Centrally: eithmoid bone 10/27/2014 4
  • 5. “Anterior cranial fossa and their structures” 10/27/2014 5
  • 6. Middle cranial fossa: accommodates the temporal lobes of the brain. The petro-occipital fissure subdivides the middle cranial fossa into 1 central component and 2 lateral components. Boundaries: • Anteriorly: Greater wing of sphenoid bone. • Posteriorly: superior borders of petrous part of temporal. • Laterally: squamous part of temporal and some part if parietal and greater wings of sphenoid. • Centrally: sella tursica (or sella turcica) of body of sphenoid. 10/27/2014 6
  • 7. Middle cranial fossa and their structures 10/27/2014 7
  • 8. Posterior cranial fossa: accommodates the cerebellum, pons, and medulla oblongata of the brain (occipital lobes). Boundaries: • Anteriorly: superior border of the petrous part of temporal bone. • Posteriorly: lesser part of the occipital squamous. • Laterally: Temporal & parietal bone. • Floor: Occipital bone. • Centrally: Foramen magnum. The anterior cranial fossa is separated from the middle cranial fossa by the lesser wing of the sphenoid, and the middle cranial fossa is separated from the posterior cranial fossa by the petrous part of the temporal bone. 10/27/2014 8
  • 9. Posterior cranial fossa and their structures 10/27/2014 9
  • 10. NASAL CAVITIES: The nasal cavities extend from the anterior apertures (nares) to the posterior apertures (choanae). The nasal cavities are separated: • from each other by a midline nasal septum. • from the oral cavity below by the hard palate. • from the cranial cavity above by parts of the frontal, ethmoid, and sphenoid bones. Each nasal cavity has:  Floor.  roof.  medial wall.  lateral wall. 10/27/2014 10
  • 11. Nasal cavities (anterolateral view). 10/27/2014 Relationship to other cavities. 11
  • 12. Roof: Formed by: •Body of sphenoid. •Cribriform plate of ethmoid bone. •Frontal bone. •Nasal bone & cartilage. •vomer. 10/27/2014 12
  • 13. Floor: Formed by the hard palate (palatine process of the maxilla, and the horizontal plate of the palatine bone ) 10/27/2014 13
  • 14. Medial Wall (Nasal Septum): Formed by: • Superiorly by the vertical (perpendicular) plate of ethmoid bone. • Posteriorly by the vomer bone. • Anteriorly by the septal cartilage. • small contributions by frontal, palatine, sphenoid and maxillary bones. 10/27/2014 14
  • 15. Lateral wall: The lateral wall of each nasal cavity is complex and is formed by bone, cartilage, and soft tissues. Bony support for the lateral wall is provided by:  the ethmoidal labyrinth and uncinate process.  the perpendicular plate of the palatine bone.  the medial plate of the pterygoid process of the sphenoid bone.  the medial surfaces of the lacrimal bones and maxillae.  the inferior concha. 10/27/2014 15
  • 16. Lateral wall: The lateral wall is characterized by three curved shelves of bone (conchae), which are one above the other and project medially and inferiorly across the nasal cavity. The conchae divide each nasal cavity into four air channels:  an inferior nasal meatus between the inferior concha and the nasal floor.  a middle nasal meatus between the inferior and middle concha.  a superior nasal meatus between the middle and superior concha.  a spheno-ethmoidal recess between the superior concha and the nasal roof. 10/27/2014 16
  • 17. Floor, roof, and lateral walls. Conchae on lateral walls. 10/27/2014 17
  • 18. The superior and middle conchae are parts of the ethmoid bone, whereas the inferior concha is a separate bone. The conchae increase the surface area of the nasal cavity 10/27/2014 18
  • 19. The recess & meati receive the openings of the: Paranasal sinuses. Nasolacrimal duct.  Sphenoethmoidal recess: Receives the opening of the sphenoidal sinus.  Superior meatus: Receives the opening of the posterior ethmoidal sinus.  Inferior meatus: Receives the opening of the nasolacrimal duct. The opening is guarded by a valve, a fold of mucous membrane 10/27/2014 19
  • 20. Middle meatus: •Shows a rounded eminence, the ethmoidal bulla, caused by the bulging of the underlying middle ethmoidal sinus, which opens on its upper border. •A curved groove, hiatus semilunaris, lies below the bulla. Hiatus receives the opening of the maxillary sinus. •Anterior end of hiatus leads to funnel-shaped infundibulum, which receives the openings of the frontal & the anterior ethmoidal sinuses. 10/27/2014 20
  • 21. Paranasal sinuses and meatuses 10/27/2014 21
  • 22. Regions of the nasal cavities 10/27/2014 22
  • 23. Gateways to the nasal cavities 10/27/2014 23
  • 24. Blood Supply and Innervation 10/27/2014 24
  • 25. Endoscopic Endonasal Removal of Pituitary Tumors: The endoscopic endonasal transsphenoidal procedure is a new and minimally invasive approach for the resection of pituitary tumors. 10/27/2014 25
  • 26. Who is Dr. Moreland ? Dr. Moreland has pioneered this technique both locally and internationally. He has one of the largest series in the country utilizing this procedure. Benefits of endonasal endoscopic surgery:  Results in less pain and a faster recovery than traditional surgery.  Does not leave a visible scar on the face or scalp.  Allows the patient to start radiation therapy, if needed, almost immediately, without waiting for incisions to heal. 10/27/2014 26
  • 27. Procedure: The procedure involves passing a 4mm rigid endoscope into the nostril to provide illumination and visualization. No incision is made nor is it necessary to break the nose with this new technique. Both of these maneuvers are necessary with the older traditional approach and they are a great source of pain and longer hospital stays. The sphenoid sinus and pituitary fossa are then entered using microsurgical instruments. The anatomy as seen by the endoscope is projected onto a television monitor as the surgeon resects the tumor. 10/27/2014 27
  • 28. Sources: imueos.wordpress.com Gray’s anatomy book Nether’s clinical anatomy book www.hopkinsmedicine.org buffaloneuro.com From others presentations 10/27/2014 28
  • 29. Thank you for your attention 10/27/2014 29