Cranial Fossa Research Articles

Detailed analysis of skull morphology and brain size in crested Padovana chicken (Gallus gallus f.d.)

IntroductionCrested chickens show abnormalities in their anatomy of the skull, endocranium, and brain (including cerebral elongation) and can be appropriate model systems for neuroanatomical evolution, brain–skull integration, and skull and brain deformities. Here, we give a detailed comprehensive description of the skull of crested chickens using the example of the Padovana chicken, including ontogenetic aspects and an allometric analysis of their brain size.MethodsIn total, 109 chickens of two different strains of the Padovana chicken were hatched together. All animals were X-rayed weekly during growth. Nine juvenile (ready for hatch) and 22 adult skulls were processed for histology and morphological descriptions, and a further 20 individuals were processed for brain analysis.ResultsAt hatching, all chicks were already crested, and a distinctive bony protuberance was first observed at the age of 4 weeks. Juvenile chickens exhibit either an open neurocranium or a protuberance. In the adult skull, foramina of different sizes can be found in the frontal bone, but no completely open neurocrania are observed in juveniles. Particularly in Padovana with cranial protuberances, several peculiarities can be observed in the os mesethmoidale, os nasale, os praemaxillare, orbit, and cranial fossae. Additionally, the brain of Padovana with cranial protuberances looks drawn in length with the shape of an hourglass and showed significantly larger encephalization indices than plain-headed breeds, topped only by another crested chicken breed.DiscussionInvestigations on chickens with cerebral elongation may facilitate the understanding of skull and brain dysplasia and may provide meaningful insights into cerebral hernia development. Additionally, crested breeds, combined with standard chickens, form a promising comparative system for investigating the emergence of novel brain and skull morphologies.

Terminal facial nerve palsy – A diagnostic dilemma

The pterional or frontotemporal sphenoidal approach to craniotomy is an extensively used neurosurgical technique to expose different structures in cranial fossae. Two middle-aged patients presented to the clinic with loss of forehead creases, and unilateral brow ptosis. This article aims to detail the findings in two patients with selective frontal branch of facial nerve palsy after undergoing craniotomy through the pterional approach. Though facial nerve palsy is classified as upper motor neuron/lower motor neuron palsy, this case scenario highlights the importance of isolated involvement of the frontal branch of the facial nerve. Thus, it is important to highlight these findings to create awareness among ophthalmologists who may come across such a clinical picture while examining neurosurgery patients so that they are better enabled to localize the cause.

Rare case of mortality after hemorrhagic property of esthesioneuroblastoma

Esthesioneuroblastoma is a tumor arising from olfactory neuroepithelium with an incidence of four per million. This case presents a rare nasal cavity neoplasm with hemorrhagic properties that may lead to significant sequelae. We present a 69-year-old male patient who presented with worsening altered mental status over the past 6-7 months. His Glasgow coma scale was a nine, showing a large mass centered at the cribriform plate with extension intracranially, sinonasal cavity, and bilateral orbits on diagnostics. Bifrontal craniotomy was performed one day after admission with resection of the tumor in the cranial fossa and intranasally, and decompression of the brainstem, frontal lobes, and third ventricle. After surgery, the patient was managed in the intensive care unit but continued to deteriorate. He was confirmed to have no meaningful brain activity and eventually deceased seven days after admission. Depending on the tumor stage, esthesioneuroblastoma can have a favorable prognosis with proper therapies. Different surgical techniques for ENB lead to the question of which therapeutic modality is the best because of the tumor's gross hemorrhagic properties. With adjunctive radiation therapy and/or chemotherapy, more research can bring light to proper surgical techniques.

Clinico-otoneurological assessment of the early postoperative outcome in surgical treatment of Chiari malformation and syringomyelia

although the pathology of Chiari malformation is extensively studied, many questions have not yet been solved. In particular, the clinical manifestations of this pathology have not been studied in detail entailing the lack of the unified approach for the optimal complex of the diagnostic workup and the selection of the optimal surgical intervention. These questions remain the point of discussion in the scientific literature. The present study is based on the retrospective analysis of the diagnostic findings and treatment outcomes of 59 patients – 24 males (40.7 %) and 35 females (59.3 %) – treated in the Department of spinal cord pathology of the State Institution "Romodanov Neurosurgery Institute, the National Academy of Medical Sciences of Ukraine" in 2010-2020. The age of the patients ranged from 16 to 50 years (36.9 ± 3.7 on the average). All patients were examined according to the conventional standards allowing for the assessment of the pre- and postoperative disease course. The following surgical interventions were provided: bone decompression for the inferior parts of the cerebellum at the upper cervical level; the recovery of the CSF flow at the region of craniovertebral junction; the expansion of the space in the fossa cranii posterior and/or craniovertebral junction. The data were processed and analyzed with the aid of STATISTICA 13 software. The quantitative variables were compared by non-parametric methods. The aim of the study was to analyze the preoperative and early postoperative clinico-otoneurological status in patients with Chiari malformation and syringomyelia. The clinical aspects of the disease were evaluated. Most clinical signs and symptoms in patients with Chiari malformation were associated with otolaryngological disturbances (hearing impairment, tinnitus, hoarseness, vertigo, etc.) and cerebellar signs (ataxia, nystagmus). Taking into account non-specific signs and symptoms of the disease, the otoneurological evaluation in these patients is undoubtedly of high importance for the preoperative differential diagnosis as well as the postoperative assessment of treatment outcome. The further study of the problem will allow us to timely diagnose Chiari malformation, to predict the course of the disease and the risk of the possible complications providing the clinicians with important information for decision-making on the optimal treatment strategy. The clinical and instrumental otoneurological examination is an important component of the systemic assessment of the clinical-and-functional status of patients with syringomyelia caused by Chiari malformation that allows for objectifying the dynamics of the otoneurological aspects of the disease in the course of the treatment.

Quantitative evaluation of the thickened dura mater impacting clinical signs in immune-mediated hypertrophic pachymeningitis

ObjectiveThis study evaluated the volume of thickened dura mater lesions and their impact on clinical findings in immune-mediated hypertrophic pachymeningitis (HP). MethodsThe volume of contrast-enhanced dura mater on magnetic resonance imaging was evaluated using the imaging feature quantification system in 19 patients with immune-mediated HP, including 12 with antineutrophil cytoplasmic antibody-related, 4 with IgG4-related, and 3 with idiopathic HP, as well as 10 with multiple sclerosis (MS) as controls. The implications of HP volume on neurological manifestations and cerebrospinal fluid (CSF) laboratory markers were statistically analyzed in patients with immune-mediated HP. ResultsThe volumes of the contrast-enhanced dura mater in the convexity, cranial fossa, and tentorium cerebelli were significantly higher in patients with immune-mediated HP than in those with MS. Among patients with immune-mediated HP, those with cranial nerve (CN) VIII neuropathy had a significantly higher volume of the contrast-enhanced dura mater in the cranial fossa than those without CN VIII neuropathy. The volume of the contrast-enhanced dura mater in the tentorium cerebelli was positively correlated with CSF protein levels. ConclusionQuantification of the thickened dura mater is useful for elucidating the relationship with the clinical findings in immune-mediated HP. Thickened dura mater lesions in the cranial fossa may be implicated in the development of CN VIII neuropathy. The enlargement of HP lesions in the tentorium cerebelli can increase CSF protein levels.

Total temporomandibular mandibular joint alloplastic replacement as first line treatment for condylar fracture

The treatment of condylar fractures has been the subject of debate and controversy. Open reduction and internal fixation, along with closed reduction, are the 2 main treatment modalities when well indicated and performed. In specific situations, however, the success of both treatment modalities can be challenged by local or systemic conditions. Alloplastic total temporomandibular joint replacement (TMJR) with the current systems, Biomet and Stryker, has proven to be successful in the long-term. The authors present 2 cases and propose the consideration of TMJR as a first-line treatment for condylar fractures in the following situations: fractures older than 4 weeks; 2) elderly patients with severely dislocated or displaced condyles; 3) condylar dislocation into the cranial fossa; 4) maxillomandibular fixation is not a viable option.

Time course of sutural width during the physiological growth from birth to adulthood: CT quantitative and qualitative evaluations of sutural arches.

We performed a retrospective qualitative and quantitative evaluation of the sutural changes during the physiological growth to define the age-related ossification stages of major and minor skull sutures or synchondroses. A total of 390 healthy subjects, examined for cranio-facial trauma and whose CT scans turned out to be normal, were clustered into homogenous age-matched groups ranged from birth to 90years. High-resolution CT was used to assess the degree of sutural closure according to a 3-grade scoring system, the sutural pattern, the width, and the density of the gap calculated as the average of two or three ROIs along each suture/synchondrosis. The identification of a definite pattern depended on the suture's type, the closure degree, and the width of the gap (p < 0.001). The interdigitation process was more intricate for most of vault sutures than the skull base sutures/synchondroses. Closing grades 1, 2, and 3 were associated to an identifiable sutural pattern and the cutoff value of 1.45mm of the gap width allowed to detect an identifiable sutural pattern with the best combination of sensitivity (97%) and specificity (98%). Age and sutural closing degree were inversely related to gap width while positively related to the gap density (p < 0.001). The sutural ossification is an age-related process, distinctive for each suture, and synchondrosis; it occurs neither according to a predefined order along sutural arches nor following a sequential distribution in the cranial fossae, and some sutures continued their growth process during lifetime.

Two-Stage Resection of a Giant Trigeminal Schwannoma in a Non–Neurofibromatosis Type 2 Pediatric Patient: A Case Report, Systematic Review, and Intraoperative Video

Trigeminal schwannoma is an uncommon tumor in pediatric patients. Several surgical approaches have been described in the literature. The case of an 11-year-old boy with a giant dumbbell-shaped trigeminal schwannoma removed through a 2-stage approach was presented with an intraoperative video. Using PubMed and Scopus, the literature on trigeminal schwannoma in pediatric patients was searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The search strategy yielded 312 titles, of which 13 were included in the review. Cases of trigeminal schwannoma were described, with a highly variable clinical presentation and anatomical arrangement in cranial fossae. Two-stage approaches were reported, although most studies described single-stage approaches. Common postoperative outcomes were a range of disturbances of cranial nerve V. The surgical approach varies based on the tumor conformation. However, a 2-stage pterional subtemporal and semisitting retrosigmoid approach is a safe, practical, and effective strategy for the removal of dumbbell-shaped trigeminal schwannoma in a pediatric patient.

Xanthogranulomatous epithelial tumors and keratin-positive giant cell-rich soft tissue tumors: two aspects of a single entity with frequent HMGA2-NCOR2 fusions

AbstractXanthogranulomatous epithelial tumor (XGET) and keratin-positive giant cell-rich soft tissue tumor with HMGA2-NCOR2 fusion (KPGCT) are two recently described neoplasms with both distinct and overlapping clinical and histopathologic features. We hypothesized that XGET and KPGCT may be related and represent a histologic spectrum of a single entity. To test this, we sought to characterize the clinical, radiographic, immunohistochemical, ultrastructural and molecular features of additional tumors with features of XGET and/or KPGCT, which we refer to descriptively as keratin-positive xanthogranulomatous/giant cell-rich tumors (KPXG/GCT). The archives were searched for potential cases of KPXG/GCT. Clinical and imaging features were noted. Slides were assessed for histologic and immunohistochemical findings. Ultrastructural and next generation RNA sequencing-based analysis were also performed. Nine cases were identified arising in seven women and two men [median age of 33 years (range: 12–87)]. Median tumor size was 4 cm (range: 2.4–14.0 cm) and tumors presented in the thigh (2), buttock (1), forearm (2), groin (1), cranial fossa (1), ilium (1), and tibia (1). Morphologically, tumors were most frequently characterized by a fibrous capsule, with associated lymphoid reaction, enclosing a polymorphous proliferation of histiocytes, giant cells (Touton and osteoclast-types), mixed inflammatory infiltrate, hemorrhage and hemosiderin deposition, which imparted a variably xanthogranulomatous to giant cell tumor-like appearance. One case clearly showed mononuclear cells with eosinophilic cytoplasm characteristic of XGET. All cases expressed keratin and 7 of 9 were found to harbor HMGA2-NCOR2 fusions including cases with xanthogranulomatous appearance. One patient developed local recurrence and multifocal pulmonary lesions, which were radiographically suspicious for metastases. Shared clinical, histologic and immunohistochemical features, and the shared presence of HMGA2-NCOR2 fusions supports interpretation of KPXG/GCT as a single entity which includes XGET and KPGCT. Given limited clinical follow-up to date and rare cases with apparently aggressive findings, we provisionally regard these tumors as having uncertain biologic potential.

ODP317 Hypophysitis or No? A Rare Case of Bipolaris Fungal Sinusitis Causing Severe Pituitary Inflammation.

Abstract Clinical case: A 28 year old male with uncontrolled diabetes mellitus presented to the hospital with severe, worsening holo-cephalic headache associated with fevers, light sensitivity which was unresponsive to pain medications. Initial CT of the brain showed severe paranasal sinus disease. Lumbar puncture was significant for elevated protein and cell count with neutrophilic predominance and negative CSF culture. Patient was empirically treated for meningitis. Due to no improvement in his symptoms, MRI brain with contrast was done that showed complete opacification of the left sphenoid sinus with partial opacification of the ethmoid sinus. Of note, heterogeneous enlargement and enhancement of pituitary gland including portion of distal infundibulum was seen with mild compression of optic chiasm. High dose dexamethasone was initiated. Pituitary workup revealed preservation of all axes including AM cortisol 36.5 mcg/dL (6.6mcg/dl- 33 mcg/dl), prolactin 2.9 ng/ml (2.1ng/ml-17.7ng/ml), TSH 1.4 uIU/mL (0.34-5.6 uIU/mL), FT4 0.99 uIU/mL (0.80-1.80 uIU/mL) with normal serum chemistry and hemodynamics. Repeat MRI brain showed sphenoid pyomucocele with infection extending to the sella, cavernous sinuses and anterior/middle cranial fossas. ENT surgery was emergently performed with surgical debridement of the sphenoid and ethmoid sinuses revealing green cement like debris causing posterior septal perforation from the pressure. Interestingly, ethmoid sinus fluid culture grew Bipolaris fungal species. Patient's condition gradually improved and he was discharged on oral itraconazole with steroid taper. The patient did not develop signs or symptoms of hypophysitis during his hospital course. Presentation: No date and time listed

Employing Spherical Harmonics in Assessing the 3D Shape Variation and Evolutionary Potential of Human Sphenoidal Sinuses

The evolutionary potential and shape variation of the human sphenoidal sinus are unknown. Moreover, a consensus about the function or evolutionary forces that influence variation of paranasal sinuses among humans remains unestablished. One initial approach to address this lies in determining the covariance of sinus shape with surrounding morphology. The sphenoidal sinus is centrally located within the basicranium at the intersection of the three cranial fossae, and is adjacent to the synchondroses where primary cranial base angulation occurs. The angulation of the cranial base and its relative orientation with the face is a distinctive, derived trait in Homo sapiens and is important to our understanding of the evolution of our species. Yet, the shape of the sphenoidal sinus is highly variable and cannot be quantified with traditional landmarking methods. Originally developed in gravitational physics, spherical harmonics has been successfully leveraged in biological morphological studies to quantify and assess 3D shape variation of complex structures. This research will use spherical harmonics to for the first time quantify the 3D shape of the sphenoidal sinuses and assess their covariation with the sphenoid body. By demonstrating the utility of spherical harmonics for human morphometric research, we are opening up new ways for investigating biological and evolutionary questions of human anatomical features that to date have been difficult to evaluate.Here we preliminarily analyze the covariance of sphenoid sinus and basicranial shape. The sphenoidal sinuses of 120 human crania were segmented (Avizo) from CT scans. We quantified the three‐dimensional shape variation of sphenoidal sinuses using spherical harmonic analyses (SHARM, Matlab), producing coefficients comparable to traditional landmarks placed virtually on the basicranial surface. Landmarks were chosen that capture the general shape of the sphenoid body. Two‐Block Partial Least Squares (2B‐PLS) analyses revealed no significant covariation (p=0.59) between the shape of the sphenoidal sinus and its surrounding bony architecture. This indicates the establishment of sinus shape occurring independently of the surrounding bone. This is contrary to previous research, which has suggested that paranasal sinuses opportunistically pneumatize within the available space of their respective cranial bones. Future research will need to investigate this relationship further with additional sets of landmarks representing different developmental regions and functional matrices that interface with the sphenoid body. This research is also foundational to investigate to what extent mutual constraint among these traits may exist in the ability to respond to natural selection, i.e. evolvability.

CRUSH SMEAR'/ 'SQUASH PREPARATION' OF BRAIN TUMORS AND ITS CORRELATION WITH HISTOPATHOLOGY

Introduction: The therapeutic management of brain tumors is based on accurate knowledge of their size, anatomic location in the cranial fossa and the histologic type with specialized CT and MRI techniques the exact location and extent of tumorile spatial delienation can be well marked, however the exact nature of lesion can only be ascertained by the microscopic examination of the lesion.Aims:To study the crush cytology of brain tumors and give provisional or tentative diagnosis about the nature of lesion and to correlate the cytologic appearance of brain tumors with their histopathological appearance. Material and method: Patients suffering from any form of brain tumor (primary or secondary) of any age and sex were included in this prospective study comprising of 50cases, admitted in the neuro surgery department of MDM hospital associated to Dr. S.N. Medical College, Jodhpur. Findings of neurologic examination, CT scan reports and other relevant investigations like haemoglobin, TLC, DLC, ESR, blood sugar, blood urea, and complete urine examination, were taken into account. Result: As is clear the above table depicting the incidence of various brain tumors. Astrocytomas were the commonest type of tumors (38%) case in the study followed by meningiomas (32%) case and medulloblastoma (10%). Case of schwanomma (12%) included the spinal forms also. Conclusion: The crush smear /squash preparation technique is a very useful and suitable method for the rapid intraoperative diagnosis of brain tumours. It has the advantages of being simple, easy and cost effective. With increasing experience, of the pathologist in this technique the interpretation of smears becomes more easy and accurate. It can be a valuable aid, as means of presumptive diagnosis of brain tumours and can supplement the histological sections in difcult cases to conrm or refute a particular diagnosis.

Retrograde mastoidectomy with canal wall reconstruction versus intact canal wall tympanomastoidectomy for cholesteatoma with minimal mastoid extension.

Appropriate reconstruction of the canal wall or maintenance of the middle ear pressure in cholesteatoma may help in preventing recurrence. Retrograde mastoidectomy with canal wall reconstruction (RMR) can overcome the challenge of a wider canal wall defect or temporal bone immaturity, which possibly increases the recurrence risk. This study compared the outcomes of RMR and intact canal wall tympanomastoidectomy (ICW) for cholesteatomas with minimal mastoid extension and quantitatively evaluate the relationship between anatomical features and recurrence. This single-center retrospective cohort study included patients who had undergone primary ICW or RMR for pars flaccida cholesteatoma with minimal mastoid extension from 2009 to 2019. The main outcome measures were anatomical measurements of the shortest distance between the cranial fossa and the upper canal wall (SCU), attic volume, and bony defect area of the canal wall (BDC) on computed tomography; recidivism; and postoperative air-bone gap (ABG). There were no significant differences in the preoperative anatomical factors, recidivism incidence, and postoperative ABG between the RMR (n = 20) and ICW (n = 60) groups. However, the median BDC was significantly greater in the RMR group (58.3 vs. 37.0 mm2). There was no significant difference in the SCU and attic volume between patients with and without recurrence. Selection of RMR or ICW may not affect recidivism and hearing outcomes in cholesteatoma with minimal mastoid extension. Bony defect size and attic narrowness were not associated with recurrence. Considering wider visualization and one-staged operation, RMR can be more adaptable than ICW for cholesteatoma with minimal mastoid extension.

Anatomical Significance of the Concept of the Confluens of the Subarachnoid Space. Implications in Forensic Investigation

The existence of a large number of unsolved issues concerning topografic and structural anatomy of the accumulation (the confluens) and draining (the cistern) compartments of the cerebrospinal fluid from within the subarachnoid space required the analysis of the determining factors that lie at the basis of nomenclature, localization and evaluation of the latter in the sites of the cerebral fossae. The investigation was carried out on 10 brains, 6 taken from adult corpses aged between 45 and 60 years of age and 4 from newborn corpses free from acute, chronic or posttraumatic lesions. Multifactorial anatomy analysis, of the geometric form, its spatial orientation and limitation was carried out on the compartmenting structures. (the confluents and the cisterns), as well as on the arterial and vein vascular structures grouped into 4 cerebral fossae : the rostral cerebral fossa, the basal cerebral fossa, the dorsal cerebral fossa and the caudal cerebral fossa permanently in biunivocal correspondence with the cranial fossae. We believe that the existence of arteries in the cerebral fossae ensures the rhythmicity of the pulsations upon the compartmental structures, the draining of the cerebrospinal fluid into the subarachnoid space. It is equally important to approve that the accumulation compartments of the cerebrospinal fluid should be called confluents of the subarachnoid space, its acceptance in the International Anatomic Terminology repairing a historic error regarding this concept. The results of our study have important implications both in forensic neuropsychiatry as well as in investigation neurosurgery with the view of carrying out the punctures of the confluens.

Lambdoid synostosis: endoscopic craniectomy.

Lambdoid craniosynostosis leads to significant deformational changes of the calvaria and cranial fossae. Surgery used to treat the condition typically consists of a calvarial vault remodeling (CVR) procedure whereby the entire occiput is removed and reshaped along with a bandeau advancement to give the patient a rounded occiput. As an option, this video presents the minimally invasive endoscopic craniectomy used at the author's institution, which was developed there and has been successfully used for 25 years. This procedure is simple and can be done rapidly, with minimal to no blood loss. The video details the key steps necessary to successfully perform the procedure.The video can be found here: https://vimeo.com/515746378.

Giant Cell Tumor of the Temporal Bone With Skull Base and Middle Ear Extension

We report on a patient who presented to the ear, nose, and throat (ENT) clinic with an 8-month-old left non-pulsatile tinnitus. Imaging studies, Neck computed tomography (CT) and magnetic resonance imaging (MRI) revealed soft tissue mass in the left middle ear with invasion to the middle cranial fossa and external auditory canal. J Med Cases. 2021;12(4):149-151 doi: https://doi.org/10.14740/jmc3627

Foramen caecum medullae oblongatae in the history of anatomical terminology

Foramen caecum is an opening in an organ or tissue ending blindly. There is, first, a Foramen caecum ossis frontalis in the fossa cranii anterior, rostral of the crista frontalis. The vena emissari...

Olfactory neuroblastoma

The article describes a classic case of olfactory neuroblastoma in a 33-year-old female patient diagnosed with «nasal cavity&#x0D; neoplasm (polyp?)» who was referred to the National Centre for Neurosurgery JSC from the ENT Department of the City Hospital No. 1. The first symptoms of the tumor occurred during her pregnancy. The aggressive tumor has invaded the anterior&#x0D; cranial fossa and spread into the right half of the ethmoid sinuses and the orbit. The tumor diagnostics was complicated by the&#x0D; prevalence of symptoms of a nasal cavity neoplasm. The “olfactory neuroblastoma” diagnosis was verified by clinical observations, MRI, and pathomorphological studies. Histological examination of the tumor showed a typical structure of olfactory&#x0D; neuroblastoma. IHC examination showed an expression of neuronal differentiation markers. The degree of malignancy was&#x0D; determined by Hyams grading.

Imaging of osteochondroma of the temporomandibular joint – Report of two cases

Osteochondroma of mandibular condyle is an uncommon entity. In the temporomandibular region, they usually present as restriction in mouth opening and pain in the joint. They can grow to a large size to impinge upon the cranial fossa. We present the imaging features of two such rare cases, one was giant condylar osteochondroma and the other one was condylar osteochondroma associated with contralateral osteochondroma of the zygomatic process of the temporal bone and congenital block cervical vertebrae. Computed tomography, magnetic resonance imaging of the temporomandibular joint and bone scan findings are discussed in detail along with the follow-up of patients.

Immersive Surgical Anatomy of the Pterional Approach.

The pterional approach (PA) is a versatile anterolateral neurosurgical technique that enables access to reach different structures contained in the cranial fossae. It is essential for neurosurgical practice to dominate and be familiarized with its multilayer anatomy. Recent advances in three-dimensional (3D) technology can be combined with dissections to better understand the spatial relationships between anatomical landmarks and neurovascular structures that are encountered during the surgical procedure. The present study aims to create a stereoscopic collection of volumetric models (VM) obtained from cadaveric dissections that depict the relevant anatomy and surgical techniques of the PA. Five embalmed heads and two dry skulls were used to record and simulate the PA. Relevant steps and anatomy of the PA were recorded using 3D scanning technology (e.g. photogrammetry, structured light scanner) to construct high-resolution VM. Stereoscopic images, videos, and VM were generated to demonstrate major anatomical landmarks for PA. Modifications of the standard PA, including the mini-pterional and two-part pterional approaches, were also described. The PA was divided into seven major steps: positioning, incision of the skin, dissection of skin flap, dissection of temporal fascia, craniotomy, drilling of basal structures, and dural opening. Emphasis was placed on preserving the temporal branches of the facial nerve and carefully dissecting the temporalis muscle. The interactive models presented in this article allow for clear visualization of the surgical anatomy and windows in 360-degrees and VR. This new modality of recording neuroanatomical dissections renders a closer look at every nuance of the topography experienced by our team in the laboratory. By accurately depicting essential landmarks, stereoscopy and VM can be valuable resources for anatomical education and surgical planning.