Craniofacial and Skull Base Surgery
Core concepts
Know cranial vault anatomy, sutures, and growth, plus indications for cranial vault remodeling in syndromic craniosynostosis (raised ICP, exorbitism, airway). Understand anterior skull base anatomy: cribriform, fovea ethmoidalis, orbital roof, and the relationship to the frontal sinus and dura. Know endoscopic endonasal approaches and the nasoseptal flap for skull base reconstruction, plus multilayer repair (fascia, fat, bone) and CSF leak management. Understand lateral skull base compartments and approaches (translabyrinthine, retrosigmoid, middle fossa) and their hearing/facial nerve trade-offs. Know craniofacial resection principles and the role of multidisciplinary teams.
Traps
Questions test CSF leak prevention and repair-multilayer closure and vascularized flap reduce leak. Another trap is confusing anterior vs lateral approach indications and the hearing/facial nerve consequences. Know that nasoseptal flap pedicle is the sphenopalatine artery and that its harvest may be compromised by prior surgery. Also know when craniectomy vs cranial vault remodeling is appropriate by age and diagnosis.
Worked example / rule of thumb
Endoscopic resection of an anterior skull base tumor with a large dural defect: reconstruct with a vascularized nasoseptal flap plus fascia and fat, and consider lumbar drain. Rule of thumb: large skull base defects need vascularized reconstruction; know the sphenopalatine pedicle.