Anatomical location of the abducens nerves (VI) in the ventral approach of clival tumors
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ANATOMIC BASES OF MEDICAL, RADIOLOGICAL AND SURGICAL TECHNIQUES
Anatomical location of the abducens nerves (VI) in the ventral approach of clival tumors Vincent Jecko1 · Musa Sesay3 · Dominique Liguoro2 Received: 17 February 2020 / Accepted: 25 June 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract The aim of this work was to determine reliable anatomical landmarks for locating and preserving the abducens nerves (6th cranial nerves) during trans-facial or trans-nasal endoscopic approaches of skull base tumors involving the clivus and the petrous apex. In order to describe this specific anatomy, we carefully dissected 10 cadaveric heads under optic magnification. Several measurements were taken between the two petro-sphénoidal foramina, from the bottom of the sella and the dorsum sellae. The close relationship between the nerves and the internal carotid artery were taken into account. We defined a trapezoid area that allowed drilling the clivus safely, preserving the 6th cranial nerve while being attentive to the internal carotid artery. The caudal part of this trapezium is, on average, 20 mm long at mi-distance between the two petro-sphenoidal foramina. The cranial part is at the sella level, a line between both paraclival internal carotid arteries. Oblique lateral edges between the cranial and caudal parts completed the trapezium. Keywords Abducens nerve · Petrous apex · Petro-sphenoidal foramen · Anterior clival surgical approach
Introduction Optimal tumor resection is an essential goal of skull base tumor surgery. In transfacial or transnasal endoscopic approaches, preservation of the vessels and nerves may be challenging. Anatomical knowledge of landmarks and careful assessment of preoperative planning are essential, although local anatomy may be modified by the tumors. Unilateral or bilateral abducens nerve (6th nerve) palsy is a frequent presentation of skull base tumors involving the clivus and the petrous apex. Postoperative functional nerve recovery is often good because the palsy is often due to mass effect. However, intraoperative 6th nerve injury is frequent in extended lateral approaches especially in the middle third of the clivus.
* Vincent Jecko vincent.jecko@chu‑bordeaux.fr 1
Neurosurgery A Unit, Bordeaux University Hospital, 33076 Bordeaux, France
2
Department of Anatomy, University of Bordeaux, 33076 Bordeaux, France
3
Department of Anesthesia and Critical Care, Bordeaux University Hospital, 33076 Bordeaux, France
The main objective of this study was to determine reliable landmarks for locating and preserving the 6th cranial nerves in the ventral surgical approach of the skull base tumors mainly those with lateral extension, because the nerve position does not vary in the petro-sphenoidal foramen (Dorello).
Materials and methods Heads from 10 human cadavers have been dissected. Two of them have been injected with colored neoprene latex. After neck section, colored neoprene latex was injected, red for carotid and vertebral arteries and blue for the jug
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