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Ekanem UOI, Chaiyamoon A, Cardona JJ, Berry JF, Wysiadecki G, Walocha JA, Iwanaga J, Dumont AS, Tubbs RS. Prevalence, Laterality, and Classification of Ossified Petroclival Ligaments: An Anatomical and Histological Study With Application to Skull Base Surgery. Cureus 2023; 15:e36469. [PMID: 37090401 PMCID: PMC10117410 DOI: 10.7759/cureus.36469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 04/25/2023] Open
Abstract
Background The petroclival ligament (PL) forms the roof of Dorello's canal (DC). In humans, partial and complete ossification of this ligament have been reported. When completely ossified, DC is transformed into a bony foramen for the abducens nerve and accompanying vascular structures. As this osteological finding might have an impact on skull base surgery, this anatomical study was performed. Methodology Using 100 adult human skulls, the presence of an ossified PL was noted and classified. The diameter of the resultant bony foramen and laterality were documented. Additionally, PL was evaluated histologically in 10 heads. Results Overall, 8% of the sides were found to have partial or complete ossification of the PL. Partial ossification (type I) was noted on 3% of the sides. Completely ossified PL was identified on 5% of the sides. Some ossified ligaments (2.5%) were seen as an ossified bridge (type II), and others (2.5%) were converted into small foramina (type III). Three skulls (3%) were found to have a completely ossified ligament bilaterally. The mean diameter of the underlying DC was 0.8 mm. Partially ossified ligaments were statistically more likely to be on the right sides, and the diameter of the underlying DC was statistically smaller in type III. Histologically, the PL was found to have bone within it on three skull sides. Conclusions An ossified ligament can be found on imaging of the skull base. Moreover, during surgical approaches to the petroclival region and, specifically, DC, skull base surgeons should be cognizant of this anatomical variation.
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Affiliation(s)
| | - Arada Chaiyamoon
- Department of Anatomy, Faculty of Medicine, Khon Kaen University, Khon Kaen, THA
| | - Juan J Cardona
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - J Franklin Berry
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - Grzegorz Wysiadecki
- Department of Anatomy and Histology, Medical University of Poland, Lodz, POL
| | - Jerzy A Walocha
- Department of Anatomy, Jagiellonian University Medical College, Krakow, POL
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University, St. George's, GRD
- Department of Neurosurgery and Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, USA
- Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, USA
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Clarke E, Golberg M, Smędra A, Mazur M, Mazurek A, Balawender K, Barszcz K, Żytkowski A. Bilateral caroticoclinoid foramen and unilateral abducens nerve canal found on the fetal skull – Case report. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2022.100224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Kontzialis M, Ahmed AK, Gallia GL, Texalidis P, Aygun N, Blitz AM. High resolution 3D magnetic resonance imaging of Gruber's ligament: a pilot study. SURGICAL AND RADIOLOGIC ANATOMY : SRA 2022; 44:1157-1163. [PMID: 35909192 DOI: 10.1007/s00276-022-02996-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 07/20/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Gruber's ligament (GL), a surgical landmark, extends from the lateral upper clivus to the petrous apex (PA), forming the superior boundary of Dorello's canal (DC). It overlies the interdural segment of the abducens nerve (CN VI). High-resolution 3D skull base MRI (SB-MRI) demonstrates anatomic details visible to the surgeon, but not well seen on traditional cross-sectional imaging. The aim of this study was to demonstrate visualization of the GL and its relationship to CN VI utilizing contrast enhanced high-resolution SB-MRI. METHODS Two neuroradiologists retrospectively reviewed in consensus the SB-MRIs of 27 skull base sides, among 14 patients. GL detection rate, confidence of detection, and GL length were recorded. When GL was successfully identified, the position of the interdural segment of CN VI within DC was recorded. RESULTS GL was readily identified in 16 skull base sides (59%), identified with some difficulty in 2 skull base sides (7%), and failed to be identified in 9 skull base sides (33%). The mean GL length was 7.1 mm (4.5-9.3 mm). Among the 18 cases where GL was successfully identified, CN VI was readily identified in all cases (100%), coursing the lateral third of DC in 72% of sides, and middle third in the remaining 28% of sides. CONCLUSION GL can be identified in approximately two-thirds of cases utilizing 3D high resolution SB-MRI. CN VI passes most commonly along the lateral third of DC. This is the first report demonstrating visualization of GL and its relation to CN VI, on imaging.
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Affiliation(s)
- Marinos Kontzialis
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St Clair Street, Chicago, IL, 60611, USA.
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gary L Gallia
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pavlos Texalidis
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nafi Aygun
- Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Ari M Blitz
- Department of Radiology, Case Western Reserve University School of Medicine University Hospitals, Cleveland, OH, USA
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Żytkowski A, Clarke E, Musiał A, Dubrowski A, Mazur M, Iwanaga J, Tubbs RS, Wysiadecki G. Atypical attachment of the petrosphenoidal (petroclival) ligament to the posterior genu of the cavernous internal carotid artery – Case report. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2022.100185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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5
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The effect of morphological variability of Dorello's canal on surgical procedures - a review. Ann Anat 2022; 243:151939. [PMID: 35378252 DOI: 10.1016/j.aanat.2022.151939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/26/2022] [Accepted: 03/27/2022] [Indexed: 11/22/2022]
Abstract
Dorello's canal is an arched structure of bone-fibrous character located in the petroclival venous confluence atop the petrosal bone in the petroclival region. It is bordered by the petrosphenoidal ligament, the petrous part of the temporal bone and the lateral border of the upper part of clivus. Its content in the vast majority of variants comprises the abducens nerve, the inferior petrosal sinus, the venous drainage and the dorsal meningeal artery or its medial branch. With the development of microsurgical techniques, this area has gained huge clinical importance, mainly concerning the order in which the above-mentioned elements (especially the position of the abducens nerve) are arranged in relation to each other. These structures appear in different variant forms and necessitate an individual clinical approach. The main purpose of this review is to present condensed information about possible intercorrelations among them and to indicate, on the basis of the available literature and research, possible surgical approaches and the need to consider the variability when treatments in this region are planned.
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Evaluation of Physiological Intracranial Calcifications in Children Using Computed Tomography. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2020. [DOI: 10.2478/sjecr-2020-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction. Physiological intracranial calcifications have an increasing prevalence with the age and can be found in both children and in adults. These calcifications are basically asymptomatic and their presence can only be noticed through neuro-imaging.
The aim of the paper was to evaluate physiological intracranial calcifications in children using computed tomography, in our conditions.
Materials and methods. The study was designed as a retrospective, observational, non-randomized clinical study. It was conducted at the Department of Radiology, Clinical Center Kragujevac, Serbia. The study included all the patients scanned by CT from 1st October, 2008. to 30th September, 2018.. The criteria for the inclusion were: the patients aged up to 18 years who underwent a non-contrast computed tomography in the observed period, with diagnosed intracranial calcifications that do not have pathological etiology.
Results. Our study included 420 patients. Out of them, 213 (50.7%) were boys and 207 (49.3%) were girls. The mean age was 12.47. We divided the patients into two age categories: the first one included the patients aged 1 to 10 years and the other one included the patients aged 11 to 18 years. Our study has demonstrated that physiological intracranial calcifications are the most frequent in habenula (28.1%), followed by the pineal gland (22.6%) and choroid plexus (18.8%).
Conclusion. There is a small number of studies with the subject of physiological intracranial calcification distribution, especially in children. It is important to know in which locations we can expect physiological intracranial calcifications, as well as the age in which they become detectable by imaging, in order not to mix them with hemorrhages, pathological tumor or metabolic mineralization.
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Iwanaga J, Altafulla JJ, Gutierrez S, Dupont G, Watanabe K, Litvack Z, Tubbs RS. The Petroclinoid Ligament: Its Morphometrics, Relationships, Variations, and Suggestion for New Terminology. J Neurol Surg B Skull Base 2019; 81:603-609. [PMID: 33381363 DOI: 10.1055/s-0039-1692699] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/11/2019] [Indexed: 10/26/2022] Open
Abstract
The anatomy and definition of the petroclinoid ligament (PCL) and its relationship with the abducens nerve are variably described. The goal of this study was to clarify the anatomy of the PCL and better elucidate its relationship with the abducens nerve. Thirty-six sides from 18 fresh-frozen adult cadaveric heads were used in this study. Specimens were all Caucasian and derived from 10 males and 8 females. The mean age at death was 79 years. Dissection of the PCL and abducens nerve was performed using a surgical microscope. The anterior and posterior attachments of the PCL, and position of the abducens nerve were noted. Subsequently, the width, thickness, and length of the ligament, and diameter of the abducens nerve were measured. Thirty-one sides (86.1%) were found to have a PCL, on two sides (5.6%), the PCL was ossified, and on three sides (8.3%), the PCL was absent. The width, thickness, and length of the PCL ranged from 0.54 to 3.39, 0.07 to 0.49, and 3.27 to 17.85 mm, respectively. No PCL had an anterior attachment onto the posterior clinoid process but rather, the clivus. Therefore, based on our findings, the PCL would be better described as the petroclival ligament.
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Affiliation(s)
- Joe Iwanaga
- Seattle Science Foundation, Seattle, Washington, United States.,Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Japan
| | - Juan J Altafulla
- Seattle Science Foundation, Seattle, Washington, United States.,Swedish Medical Center, Swedish Neuroscience Institute, Seattle, Washington, United States.,Department of Neurosurgery, Hospital Santo Tomas, Panama City, Panama
| | | | - Graham Dupont
- Seattle Science Foundation, Seattle, Washington, United States
| | - Koichi Watanabe
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Japan
| | - Zachary Litvack
- Swedish Medical Center, Swedish Neuroscience Institute, Seattle, Washington, United States
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington, United States.,Department of Anatomical Sciences, St. George's University, St. George, Grenada
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Touska P, Hasso S, Oztek A, Chinaka F, Connor SEJ. Skull base ligamentous mineralisation: evaluation using computed tomography and a review of the clinical relevance. Insights Imaging 2019; 10:55. [PMID: 31115710 PMCID: PMC6529485 DOI: 10.1186/s13244-019-0740-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/04/2019] [Indexed: 02/08/2023] Open
Abstract
Objectives To determine the frequency, morphologic and demographic characteristics, and clinical relevance of the mineralisation of six skull base ligaments (interclinoid, caroticoclinoid, petrosphenoid, posterior petroclinoid, pterygospinous, and pterygoalar). Methods This is a retrospective review of 240 CT scans of the paranasal sinuses (ages 6–80 years). A limited systematic review was performed primarily using Embase and Medline databases. Results Ligamentous mineralisation was well delineated on CT and occurred at ≥ 1 location in 58.3% of patients. There was a nonsignificant trend towards a greater incidence with advancing age. The interclinoid and posterior petroclinoid ligaments were most commonly mineralised (22.1% and 18.3%, respectively); the petrosphenoid and pterygoalar ligaments were least frequently mineralised (10.8% and 6.3%, respectively). The mean age of patients with posterior petroclinoid mineralisation was significantly greater than those with interclinoid and petrosphenoid mineralisation and was not seen in patients aged 6–20 years. The literature review highlighted the clinically relevant potential for mineralised ligaments to cause barriers to surgical access (e.g. to the foramen ovale), increase the risk of neurovascular injury during surgery at the skull base (e.g. during anterior clinoidectomy), and predispose to neural impingement. Conclusions Skull base ligamentous mineralisation is commonly encountered on CT imaging. Given the potentially significant clinical implications, an understanding of the morphological appearances is of importance to those planning interventions at the skull base. To the authors’ knowledge, this study is the first to comprehensively evaluate such a wide range of skull base ligaments using CT. For some ligaments, the incidence on CT has not been previously described.
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Affiliation(s)
- Philip Touska
- Department of Radiology, Guy's and St. Thomas' NHS Foundation Trust, 2nd Floor Tower Wing, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK.
| | - Sultana Hasso
- Department of Radiology, Guy's and St. Thomas' NHS Foundation Trust, 2nd Floor Tower Wing, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK
| | - Alp Oztek
- Department of Radiology, University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Fungayi Chinaka
- Department of Radiology, Guy's and St. Thomas' NHS Foundation Trust, 2nd Floor Tower Wing, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK
| | - Steve E J Connor
- Department of Radiology, Guy's and St. Thomas' NHS Foundation Trust, 2nd Floor Tower Wing, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK.,Department of Neuroradiology, King's College Hospital NHS Trust, Denmark Hill, Brixton, London, SE5 9RS, UK.,School of Biomedical Engineering and Imaging Sciences Clinical Academic Group, King's College London, King's Health Partners, Guy's Hospital, London, UK
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Ogden M, Ozveren MF, Kayacı S. Petrobasilar, petroclival or petrosphenoidal canal of the abducens nerve. Acta Neurochir (Wien) 2017; 159:2145-2146. [PMID: 28942544 DOI: 10.1007/s00701-017-3324-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 09/04/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Mustafa Ogden
- Faculty of Medicine, Department of Neurosurgery, Kirikkale University, Yahsihan, 71450, Kirikkale, Turkey.
| | - Mehmet Faik Ozveren
- Faculty of Medicine, Department of Neurosurgery, Kirikkale University, Yahsihan, 71450, Kirikkale, Turkey
| | - Selim Kayacı
- Faculty of Medicine, Department of Neurosurgery, Erzincan University, Erzincan, Turkey
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