Dural and Arachnoid Membraneous Protection of the Abducens Nerve at the Petroclival Region

M. Faik Ozveren; Koichi Uchida; Ibrahim Tekdemir; Bengu Cobanoglu; Ismail Akdemir; Takeshi Kawase; Haluk Deda

doi:10.1055/s-2002-35749

Skull Base 2002; 12(4): 181-188
DOI: 10.1055/s-2002-35749

ORIGINAL ARTICLE

Dural and Arachnoid Membraneous Protection of the Abducens Nerve at the Petroclival Region

M. Faik Ozveren¹ , Koichi Uchida² , Ibrahim Tekdemir³ , Bengu Cobanoglu¹ , Ismail Akdemir¹ , Takeshi Kawase² , Haluk Deda⁴

¹Firat University Medical School, Neurosurgery Department, Elazig, Turkey
²Keio University Medical School, Neurosurgery Department, Tokyo, Japan
³Anatomy Department, Ankara University Medical School, Ankara, Turkey
⁴Neurosurgery Department, Ankara Medical School, Ankara, Turkey

Abstract

ABSTRACT

The goal of this study was to determine the membranous protection of the abducens nerve in the petroclival region. The petroclival portion of the abducens nerve was studied in ten dissections from five cadaveric head specimens. One of the heads was used for histological sections. Four heads were injected with colored latex for microsurgical dissections. The histological sections were prepared from petroclival dura mater, embedded in paraffin blocks, stained, sectioned in the axial, coronal, and sagittal planes, and evaluated by light microscopy. The abducens nerve was covered by a dural sleeve and arachnoidal membrane during its course within the petroclival area. Following the petrous apex, the abducens nerve was fixed by a sympathetic plexus and connective tissue extensions to the lateral wall of the cavernous segment of the internal carotid artery and to the medial wall of Meckel's cave. Fibrous trabeculations inside the venous space were attached to the dural sleeve. The lateral clival artery accompanied the dural sleeve of the abducens nerve and supplied the petroclival dura mater. The arterioles accompanying the abducens nerve through the subarachnoid space supplied the nerve within the dural sleeve. The arachnoid membrane covered the abducens nerve within the dural sleeve to the petrous apex, and arachnoid granulations found on the dural sleeve protruded into the venous space. The extension of the arachnoid membrane to the petrous apex and the presence of arachnoid granulations on the dural sleeve suggest that the subarachnoid space continues in the dural sleeve.

KEYWORDS

Abducens nerve - arachnoid membrane - dural sleeve - petroclival region - subarachnoid space

Full Text

References

REFERENCES

1 Lang J. Skull Base and Related Structures. Atlas of Clinical Anatomy, Stuttgart: Schattauer 1995: 85-86
2 Lang J, Reiter U. Course of the abducens nerve before the exit zone from the central nervous system to the lateral rectus muscle. Neurochirurgia . 1985; 28 1-5
3 Lang J. Clinical Anatomy of the Posterior Cranial Fossa and its Foramina, Stuttgart: George Thieme Verlag . 1991: 7
4 Vail R L. Anatomical studies of Dorello's canal. Laryngoscope . 1922; 32 569-575
5 Destrieux C, Velut S, Kakou M K, Lefrancq T, Arbeille B, Santini J J. A new concept in Dorello's canal microanatomy: the petroclival venous confluence. J Neurosurg . 1977; 87 67-72
6 Barnhill J F. Surgical Anatomy of the Head and Neck. Baltimore, MD: Williams Wood and Company 1937
7 Umansky F, Elidan J, Valarezo A. Dorello's canal: a microanatomical study. J Neurosurg . 1991; 75 294-298
8 Shiu P C, Hanafee W N, Wilson G, Rand R. Cavernous sinus venography. AJR . 1968; 104 57-62
9 Dolenc V V. Anatomy and Surgery of the Cavernous Sinus. Springer-Verlag 1989 : 69-70
10 Tedeschi H, Rhoton A L. Lateral approaches to the petroclival region. Surg Neurol . 1994; 41 180-216
11 Piffer C R, Zorzetto N L. Course and relations of the abducens nerve. Anat Anz . 1980; 147 42-46
12 Tekdemir I, Deda H, Karahan S T, Arinci K. The intracranial course of the abducens nerve. Turkish Neurosurgery . 1996; 6 96-102
13 Tsitsopoulos P D, Tsonidis C A, Pestas G P, Hadjiioannou P N, Njau S N, Anagnostopoulos I V. Microsurgical study of the Dorello's canal. Skull Base Surg . 1996; 6 181-185
14 Umansky F, Valarezo A, Elidan J. The microsurgical anatomy of the abducens nerve in its intracranial course. Laryngoscope . 1992; 102 1285-1292
15 Weninger W J, Muller G B. The parasellar region of human infants: cavernous sinus topography and surgical approaches. J Neurosurg . 1999; 90 484-490
16 Arias M J. Bilateral traumatic abducens nerve palsy without skull fracture and cervical spine fracture: case report and review of the literature. Neurosurgery . 1985; 16 232-234
17 Mamata Y, Muro I, Matsumae M. Magnetic resonance cisternography for visualization of intracisternal fine structures. J Neurosurg . 1998; 88 670-678
18 Yousry I, Camello S, Wiesman M. Detailed magnetic resonance imaging anatomy of the cisternal segment of the abducens nerve: Dorello's canal and neurovascular relationships and landmarks. J Neurosurg . 1999; 91 276-283
19 Kawase T, Loveren H V, Keller J T, Tew J M. Meningeal architecture of the cavernous sinus: clinical and surgical implications. Neurosurgery . 1996; 39 527-536
20 Ziyal I M, Salas E, Wright D C, Sekhar L N. The petrolingual ligament: the anatomy and surgical exposure of the posterolateral landmark of the cavernous sinus. Acta Neurochir . 1998; 140 201-205
21 Kanpolat Y, Savas A, Berk C. Abducens nerve palsy after radiofrequency rhizolysis for trigeminal neuralgia: case report. Neurosurgery . 1999; 44 1364
22 Eisenberg M B, Al-Mefty O, Demonte F, Burson G T. Benign nonmeningial tumors of the cavernous sinus. Neurosurgery . 1999; 44 949-955
23 Kawase T, Shiobara R, Toya S. Anterior transpetrosal-transtentorial approach for sphenopetroclival meningiomas: surgical method and results in 10 patients. Neurosurgery . 1991; 28 869-876
24 Memis A, Alper H, Calli C, Ozer H, Ozdamar N. Petrous apex mucocele: high resolution CT. Neuroradiology . 1994; 36 632-633
25 Muneer A, Jones N S. Unilateral abducens nerve palsy: a presenting sign of sphenoid sinus mucoceles. J Laryngol Otol . 1997; 111 644-646
26 Sekhar L N, Pomeranz S h, Sen C hN. Extradural petrous bone and petroclival neoplasms. Acta Neurochir Suppl . 1991; 53 183-192
27 DeMonte F, Smith H, Al-Mefty O. Outcome of aggressive removal of cavernous sinus meningiomas. J Neurosurg . 1994; 81 245-251
28 Krisht A, Barnett D W, Barrow D L, Bonner G. The blood supply of the intracavernous cranial nerves: an anatomic study. Neurosurgery . 1994; 34 275-279
29 Tekdemir I, Tuccar E, Cubuk H E, Ersoy M, Elhan A, Deda H. Branches of the intracavernous internal carotid artery and the blood supply of the intracavernous cranial nerves. Ann Anat . 1998; 180 343-348