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The middle cranial fossa, also known as the central skull base, is an intricate intracranial area that contains many structures susceptible to pathology, making it an area directly pertinent to neurosurgeons, neurologists, otolaryngologists, ophthalmologists, radiologists, and endocrinologists.[1][2] The middle cranial fossa can be divided into medial and lateral portions, each containing many nerves, vessels, and cranial structures crucial to its function. In addition to its contents, the middle cranial fossa acts as a potential space for infection and hemorrhage. The complex anatomy of this region makes it a difficult area for surgeons to traverse, but also provides access to various areas of the brain for a variety of procedures. The following review article will highlight the complex structure of the middle cranial fossa while simplifying the contents and various pathologies that affect structures within the middle cranial fossa.