Operative skull base approaches

Knowledge of skull base anatomy is essential for recognizing the pathological conditions affecting the skull base structures (including cranial nerves and cerebral vasculature), for correct interpretation of their presentation on imaging studies, and finally for proper planning of surgical skull base approaches. The main goal of the following work is to present a brief recapitulation of the regular skull base anatomy (with a focus on the bony structures) and based on this, to provide an overview of the most commonly used neurosurgical skull base approaches (illustrated using radiological case presentations). Already at the step of the preoperative workup, the suitable radiological technique and proper choice of technical parameters for image acquisition lays the foundation for a successful surgical procedure and for the reliable assessment of operative results. Each radiologist should be familiar with basic principles of neurosurgical approaches and operative techniques used in skull base surgery and with their appearance in postoperative images.