Anterolateral, lateral, and posterior corridors to complex skull base lesions in sphenocavernous and petroclival regions: microsurgical anatomy with three-dimensional reconstructions and illustrative cases.

Objective: Access to complex lesions in the sphenocavernous and petroclival regions are challenging due to their deep location and proximity to critical neurovascular structures. This study aims to re-evaluate the microsurgical anatomy of the anterolateral, lateral, and posterior surgical corridors in three dimensions and present this anatomy using educational models. Methods: Pretemporal transcavernous, anterior petrosal, translabyrinthine, and far lateral approaches were performed on five cadavers. Each step was photographed, the images were processed using photogrammetry to create three-dimensional models, and 3D models were tested in an augmented reality and virtual reality environment. In addition, to correlate each anatomical corridor with its corresponding surgical application, an illustrative surgical video case was prepared for each approach. Results: Three-dimensional models were successfully created for each surgical approach in the study. The models detailed the spatial relationships of the surgical corridors in the petroclival and sphenocavernous regions and made them viewable from different angles. Tests conducted using augmented reality applications confirmed that the models could be used interactively. Conclusion: This holistic approach may be used to facilitate the selection of the appropriate corridor or combined approach based on the orientation of the lesion and its neurovascular relationships. Three-dimensional cadaveric models can be used as powerful support tools forn education and planning by enhancing spatial awareness for complex skull base surgeries.