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Superior View of the Anterior Cranial Base

Surgical Correlation

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A, Both orbits have been unroofed to expose the periorbita. The optic canals have been unroofed and the anterior clinoids removed to expose the optic nerves, which are enclosed in the optic sheath within the optic canal. The frontal, trochlear, and lacrimal nerves can be seen through the periorbita. The roof of the ethmoidal sinuses and the olfactory bulbs sitting on the cribriform plate have been preserved. The anterior cerebral arteries course above the optic chiasm. B, The intraorbital fat has been removed and the levator and superior rectus muscles have been retracted laterally to expose both globes, ophthalmic arteries, superior ophthalmic veins, and nasociliary nerves. C, The orbital contents have been removed to expose the lateral wall and floor of the orbit. The maxillary sinuses are exposed below the orbital floors. The maxillary nerves give rise to the infraorbital nerve, which courses along the floor of the orbit to reach the cheek, and the zygomatic nerve, which courses along the lateral wall of the orbit to reach the malar eminence and temple. D, Enlarged view. The optic nerves are enclosed within the optic sheath as they course through the optic canal. The annular tendon, from which the rectus muscles arise, surrounds the optic nerve and medial portion of the superior orbital fissure. Removal of the anterior clinoid exposes the clinoid segment of the carotid artery. The optic strut, which separates the optic canal and superior orbital fissure, has also been removed. The segment of anterior cerebral arteries passing above the chiasm has been removed to expose the lamina terminalis. The falciform dural fold extends across the optic nerve at the entrance into the optic canal. (Images courtesy of AL Rhoton, Jr.)

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