NASBS Skull Base Dissection Course Pre-Test

We look forward to seeing you at the upcoming the NASBS 2020 Skull Base Dissection Course on Wednesday, February 5 and Thursday, February 6.

As required by our CME provider, please complete the pre-course test below by 5pm PST on Tuesday, February 4th. You will also be asked to complete a post test following the course in order to measure the effectiveness of the activity. Information on the post test will be emailed out after the start of the course.

For any questions, please contact the NASBS office at nicole@nasbs.org.

NASBS Skull Base Dissection Course Pre-Test

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1. What is the most common site of attachment of the diaphragm sella?*
- 5 mm below the tuberculum recess
- 1 mm below the tuberculum recess
- 1 mm above the tuberculum recess
- 5 mm above the tuberculum recess
2. During an expanded Endonasal transplanum approach, the posterior anatomical limit of drilling to prevent injury to the preforaminal optic nerve is:*
- The medial OCR
- The lateral OCR
- The limbus sphenoidale
- The chiasmatic sulcus
3. Which anatomical structure is most likely at risk if an Onodi cell is present?*
- Vidian nerve
- Posterior ethmoidal artery
- Optic nerve
- Sphenopalatine artery
4. Mark the correct statement about the palatovaginal fissure:*
- It is a good reference for the lacerum segment of the internal carotid artery
- It is just lateral to the foramen rotundum
- It is medial to the vidian canal
- It is lateral to the sphenopalatine foramen
5. In order to remove the clinoid process, could you tell us what are the attachments of the anterior clinoid process to the skull base?*
- Optic strut and posterior clinoid
- Optic strut, lesser sphenoid wing and the roof of the optic canal
- Optic strut and body of the sphenoid bone
- Lesser sphenoid wing and greater sphenoid wings
6. What arterial branches most frequently arise from the meningohypophyseal trunk at the cavernous sinus?*
- The tentorial artery (Bernasconi-Cassinari), the inferior hypophyseal artery and the dorsal meningeal artery
- The tentorial artery (Bernasconi-Cassinari) and ophthalmic artery
- The inferior and superior hypophyseal arteries
- The inferior hypophyseal artery, the infero-lateral trunk and the ophthalmic artery
7. This 24 year old has a biopsy proven adenocarcinoma. What would be the best oncological treatment?*
- Endoscopic Endonasal debulking followed by radiation
- Balloon occlusion test, with potential carotid bypass and resection if necessary through a subtemporal craniotomy
- Subtemporal tranzygomatic resection of tumor from skull base and infratemporal fossa
- External beam radiation
8. What nerve in the middle fossa courses almost parallel to the greater petrosal nerve and can be mistaken for that nerve while elevating the dura covering the middle fossa?*
- Facial nerve
- Deep petrosal nerve
- Lesser petrosal nerve
- Vidian nerve
9. What nerve does it course medial to the trigeminal ganglion and can be damaged when drilling the Petrous apex medial to the trigeminal ganglion?*
- Abducens nerve
- Cochlear nerve
- Facial nerve
- Trochlear nerve
10. During the initial phase of the extradural elevation of the temporal lobe, the surgeon should systemically identify the arcuate eminence, greater superficial petrosal nerve, foramen ovale, foramen rotundum and?*
- Optic nerve
- Petrous carotid artery
- Superior orbital fissure
- Middle meningeal artery
11. This approach provides an exposure to the area anterior to the brain stem and was initially described for meningiomas. The inferior limit of the exposure is at the level of*
- Middle of the clivus
- Jugular foramen
- Internal auditory canal
- Root of the trigeminal nerve
12. If you access to the petrous apex via the transnasal approach with endoscope, which structure is not suitable for landmarks?*
- Eustachian tube
- Paraclival carotid artery
- Pterygoid process of the sphenoid bone
- Maxillary artery
13. After the endoscopic endonasal approach to the petrous apex, which complication is unlikely to occur?*
- Diplopia
- Dry mouth
- Otitis media
- Dry eye
14. Critical skull base structures that may be encountered during a transphenoidal marsupialization of a cholesterol granuloma include all of the following except:*
- Abducens nerve
- Basilar venous plexus
- Second genu of the carotid artery (medial petrous portion)
- Cavernous sinus
15. A septated, variably enhancing lesion consistent with a small chondrosarcoma of the petroclival area, inferomedial to the petrous carotid and anteromedial to the CN VII/VIII complex, is approached endoscopically through a Transpterygoid approach to the petrous apex. All of the following represent critical steps in gaining a wide endoscopic exposure of this area except:*
- Inferolateral displacement of the Eustachian tube
- Careful resection of fibrocartilagenous foramen lacerum
- Wide bony drill-out inferior to the course of the vidian nerve
- Lateral displacement of V3 at the level of the foramen ovale
16. All of the following nerves are related to the Transpterygoid approach, with the exception of:*
- Optic nerve
- Palato-Vaginal nerve
- Maxillary nerve
- Vidian nerve
17. Which one of the following is a real direct side effect of the Transpterygoid approach?*
- Loss of smell
- Dry eye
- Vision loss
- CSF leak
18. The foramen magnum is a part of which bone?*
- Temporal bone
- Temporal and occipital bones
- Occipital bone
- Sphenoidal, temporal, and occipital bones
19. During a far lateral approach for a foramen magnum lesion, which of the following structures can you safely divide to widen the surgical corridor?*
- The spinal accessory nerve
- The C2 nerve root
- The dentate ligament
- The cerebellar tonsils
20. Which segment of the vertebral artery is located in the suboccipital triangle?*
- V1
- V2
- V3
- V4
21. What two points help determine the caudal extent of access to the craniocervical junction via an endonasal approach?*
- The lateral aspect of the pyriform aperture and the superior aspect of the soft palate
- The inferior aspect of the bony nasal bridge and the superior aspect of the choana
- The inferior aspect of the bony nasal bridge and the posterior aspect of the hard palate in a sagittal plane
- The posterior aspect of the nasal septum and the superior aspect of the pyriform aperture
22. In the absence of dural defect and in the absence of CSF leak, what is the best reconstruction method after endoscopic endonasal approach for craniocervical junction pathology?*
- Posterior pharyngeal flap
- Fat graft augmentation and posterior nasal septal flap
- Non vascularized autograft or allograft
- Absorbable packing material and tissue sealant
23. Advantages to an endoscopic endonasal odontoidectomy compared to a transoral approach include all of the following except:*
- Decreased incidence of velopharyngeal incompetence and scarring
- Earlier resumption of oral feeds
- Decreased incidence of spinal instability
- Improved visualization with decreased retraction
24. All of the following are pathologies that can be treated with an endoscopic endonasal approach to the odontoid except:*
- Basilar invagination
- Rotatory subluxation
- Atlantoaxial subluxation
- Chordoma
25. Which of these is not a border of posteromedial (Kawase’s) triangle?*
- Mandibular nerve (V3)
- Greater superficial petrosal nerve
- Arcuate Eminence
- Inferior Petrosal Sinus
26. Petroclival meningiomas, by definition, are tumors that:*
- Originate from the lower 1/3 of the clivus at the petroclival junction
- Displace the brainstem anteriorly and to the contralateral side
- Displace the basilar artery posteriorly and to the ipsilateral side
- Originate medial to the trigeminal nerve
27. Which structure is anterolateral to the horizontal petrous ICA (internal carotid artery)?*
- foramen lacerum
- Gasserian ganglion
- V3
- Medial pterygoid plate
28. The abducens nerve enters Dorello’s canal medial to the paraclival ICA immediately above which bony structure?*
- Medial pterygoid plate
- Optic Strut
- Maxillary Strut
- Petrosal Process
29. Pneumatization of which structure creates the lateral OCR (opticocarotid recess)?*
- V2 and V3
- Paraclival ICA and abducens nerve
- Vidian nerve and V2
- Paraclival ICA and vidian nerve
30. Which one of the following is a real direct side effect of the Transpterygoid approach?*
- Foramen lacerum
- Maxillary strut
- Eustachian tube attachment
- Vidian nerve
31. When planning a transpterygoid approach, which of the following flaps are best pedicled on the contralateral side?*
- Nasoseptal flap
- Inferior turbinate/lateral nasal wall flap
- Temporoparietal fascial flap
- A and B
32. What is the relationship of the abducens nerve to the trigeminal branches?*
- Immediately lateral to V2
- Immediately medial to V3
- Immediately Medial to V1
- Superior to V1
33. Which tumor is typically centered around the petroclival synchondrosis?*
- Chordoma
- Vestibular schwannoma
- Chondrosarcoma
- Juvenile Nasal Angiofibroma
34. This tumor originates from the pterygopalatine fissure and vidian canal:*
- Chondrosarcoma
- Juvenile Nasal Angiofibroma
- Adenoid Cystic Carcinoma
- Trigeminal Schwannoma
35. Endoscopic Endonasal Transpterygoid Approaches can be used for trigeminal schwannomas originating from all of the following except:*
- 3 (Mandibular branch)
- V2 (Maxillary branch)
- V1 (Ophthalmic branch)
- Anterior gasserian ganglion
36. The “quadrangular space” which provides access to the Meckel’s cave via an endoscopic endonasal approach is bounded by all of the following except:*
- Vidian nerve
- Paraclival ICA
- Horizontal petrous ICA
- V2/foramen rotundum
37. Petroclival meningiomas, by definition, are tumors that:*
- Originate medial to the trigeminal nerve
- Originate from the lower 1/3 of the clivus at the petroclival junction
- Displace the brainstem anteriorly and to the contralateral side
- Displace the basilar artery posteriorly and to the ipsilateral side
38. The frontalis branch of the facial nerve has which relationship to the zygoma?*
- Passes Deep to the zygoma
- Does not cross the zygoma
- Passes Superficial to the zygoma
- Runs along the superior aspect
39. The optic strut separates which two neural structures?*
- Optic nerve and V2 (maxillary branch of trigeminal nerve)
- Superior orbital fissure and V2 (maxillary branch of trigeminal nerve)
- Abducens and oculomotor nerves
- Optic nerve and superior orbital fissure
40. Which nerve can be skeletonized and mobilized anteriorly to increase access to the petrous apex during an extended middle fossa approach?*
- Abducens nerve
- GSPN
- Maxillary branch of trigeminal (V2)
- Mandibular branch of trigeminal (V3)
41. Which orbital structure is encountered when dissecting periorbita from the frontozygomatic suture during an orbitozygomatic osteotomy?*
- Lateral rectus muscle
- Lacrimal gland
- Lateral canthal ligament
- Superior oblique muscle
42. Which of the following can be used as a landmark for the horizontal petrous ICA (internal carotid artery) during an extended middle fossa approach?*
- Arcuate eminence
- GSPN (greater superficial petrosal nerve)
- Foramen spinosum
- Foramen ovale
43. This structure is cut to identify the plane between the temporal dura and lateral cavernous sinus dura to allow peeling of the temporal dura.*
- Inferior orbital fissure
- Meningoorbital fold/artery
- Falciform ligament
- Proximal dural ring on ICA (internal carotid artery)
44. This structure is cut to allow mobilization of the optic nerve during a frontotemporal craniotomy:*
- Meningoorbital fold/artery
- Falciform ligament
- Distal dural ring (ICA)
- Middle meningeal artery
45. All of the following are landmarks of Kawase’s triangle except:*
- Arcuate eminence
- Foramen Spinosum
- GSPN (greater superficial petrosal nerve)
- Petrous ridge
46. The anteromedial/clinoidal triangle (Dolenc) is bounded by all of the following except:*
- Optic nerve
- V2 (maxillary branch of trigeminal nerve)
- Oculomotor nerve
- Tentorial edge
47. The clivus is divided into thirds during an endonasal approach based on which landmarks?*
- Sphenoid limbus and pterygoid wedge
- Floor of sella and sphenoid rostrum
- Medial pterygoid plate and sella
- Foramen magnum and paraclival ICA
48. The supracondylar groove or ridge is at the same level as which neural structure during an endoscopic endonasal approach?*
- Jugular foramen
- Hypoglossal canal
- Dorello’s canal
- Foramen ovale
49. Which of the following techniques for pituitary transposition allows maximal posterior clinoid exposure while minimizing pituitary gland disruption?*
- INTRAdural pituitary transposition
- INTERdural pituitary transposition
- Transpituitary splitting
- EXTRAdural pituitary transposition
50. Where can the nasoseptal flap be placed during a transclival approach?*
- Nasopharynx
- Frontal sinus
- Oropharynx
- Maxillary sinus
51. The odontoid should be drilled/removed in which order?*
- Transect the base of the dens first
- From the tip to the base
- Drill the C2 body first up to the base of the dens
- Lateral mass of C1 to the base.
52. All of the following are exposed during an endoscopic endonasal mid-clival resection/exposure EXCEPT:*
- Pons
- Oculomotor nerve
- Basilar trunk
- AICA (anterior inferior cerebellar artery)
53. What is the maximal percentage of the condyle that can be removed via an endoscopic endonasal approach without causing craniocervical instability?*
- 0-25%
- 25-50%
- 50-75%
- 75-100%
54. All of the following can be removed without causing significant instability except:*
- Tectorial membrane
- Transverse ligament
- Apical ligament
- Clivus
55. Petroclival meningiomas, by definition, are tumors that:*
- Originate from the lower 1/3 of the clivus at the petroclival junction
- Originate medial to the trigeminal nerve
- Displace the brainstem anteriorly and to the contralateral side
- Displace the basilar artery posteriorly and to the ipsilateral side
56. All of the following makeup the suboccipital triangle except:*
- Inferior oblique capitis muscle
- Splenius capitis muscle
- Rectus capitis major muscle
- Superior oblique capitis muscle
57. What is the maximal percentage of the condyle that can be removed via a far lateral approach without causing craniocervical instability?*
- 0-25%
- 25-50%
- 50-75%
- 75-100%
58. Which segment of the vertebral artery is localized during the initial far lateral approach?*
- V1
- V2
- V3
- V4
59. Which large emissary vein should be localized and carefully controlled with packing during a far lateral approach?*
- Sigmoid sinus
- Condylar vein
- Vein of Labbe
- Jugular vein
60. Drilling of this structure allows for maximal lateral access for dural opening superior to the vertebral artery:*
- C1 lateral tubercle
- Jugular tubercle
- Mastoid tip
- Foramen magnum
61. Which structure overlies and provides a landmark for the sigmoid sinus?*
- Mastoid tip
- Digastric groove
- Condylar emissary vein
- Inion
62. Far lateral approaches are used for all of the following except:*
- PICA aneurysms
- Vestibular schwannomas
- Foramen magnum meninigomas
- Jugular schwannomas
63. What is the typical relationships of the intradural hypoglossal nerve with the vertebral artery?*
- Hypoglossal nerve is ventral to the vertebral artery
- Hypoglossal nerve is dorsal to the vertebral artery
- Hypoglossal nerve does not cross the vertebral artery
- Hypoglossal nerve is superior to the vertebral artery
64. Which nerve lies in the cerebellomedullary cistern?*
- CN 8
- CN 9-10
- CN 11
- CN 12
65. The clivus can be schematically divided into three regions. What are the anatomic boundaries of the middle clivus in the transverse plane?*
- Between the sellar floor and the sphenoid sinus floor
- Below the floor of the sphenoid sinus
- Between the dorsum sella and the sellar floor
- Below the foramen magnum
66. Which structure does NOT pass through foramen ovale?*
- Lesser petrosal nerve
- Greater petrosal nerve
- Mandibular nerve (V3)
- Accessory meningeal artery
67. A 35-year-old female presents with right-sided cerebrospinal fluid (CSF) rhinorrhea. A thin-cut CT scan and MRI were performed which demonstrated a meningocele within the right lateral recess of the sphenoid sinus. What is the most appropriate endoscopic, endonasal approach for repair of this skull base defect?*
- Endoscopic anterior transpetrosal approach
- Endoscopic transpterygoid approach
- Endoscopic transclival approach
- Endoscopic retrosellar approach
68. Which of the following is NOT true of the location of the sphenoid sinus ostium?*
- Medial to the superior turbinate
- At a 45 degree angle from the anterior nasal spine
- Between 1.5 and 3 cm above the posterior choanae
- Within 1 cm of midline
69. What is the posterior border of the anterior cranial fossa?*
- Lesser wing of the sphenoid sinus and anterior clinoid processes
- Dorsum sella of sphenoid and superior border of petrous portion of temporal bone
- Posterior surface of clivus
- Posterior wall of frontal sinus
70. Which bony structure separates the optic canal from the superior orbital fissure?*
- Maxillary strut
- Optic strut
- Medial pterygoid plate
- Vidian canal
71. From which bone does the cribriform plate arise?*
- 6
- 12
- 24
- 36
72. The crista ethmoidalis is an important structure that helps to localize the sphenopalatine artery. From which bone does it arise?*
- Palatine bone
- Sphenoid bone
- Ethmoid bone
- Maxillary bone
73. The uncinate most commonly attaches to the*
- Skull base
- Middle turbinate
- Septum
- Lamina papyracea
74. The clivus is formed by portions of which bones?*
- Temporal and sphenoid
- Occipital and temporal
- Sphenoid only
- Occipital and sphenoid
75. Adenomas are more commonly (secreting vs nonsecreting) and the most common secreted hormone is_______?*
- Secreting / prolactin
- Secreting / growth hormone
- Non-secreting / prolactin
- Non-secreting / growth hormone
76. The crista ethmoidalis is helpful for identifying the___?*
- Sphenopalatine artery
- Skull base
- Posterior ethmoidal artery
- Vidian nerve
77. Meckel’s cave allows tumor spread between what two areas?*
- Middle cranial fossa and pterygopalatine fossa
- Posterior fossa and middle cranial fossa
- Pterygopalatine fossa and posterior fossa
- Middle cranial fossa and nasopharynx
78. Approximately what percentage of esthesioneuroblastoma patients have cervical metastases?*
- 10%
- 25%
- 45%
- 70