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Cavernous sinus and abducens nerve in human fetuses near term

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Abstract

A long tortuous course of the abducens nerve (ABN) crossing a highly curved siphon of the internal carotid artery is of interest to neurosurgeons for cavernous sinus surgery. Although a “straight” intracavernous carotid artery in fetuses can change into an adult-like siphon in infants, there is no information on when or how the unique course of ABN is established. Histological observations of 18 near-term fetuses (12 specimens of frontal sections and 6 specimens of sagittal sections) demonstrated the following: (I) the ABN consistently took a straight course crossing the lateral side of an almost straight intracavernous carotid artery; (II) the straight course was maintained when sympathetic nerves joined; (III) few parasellar veins of the developing cavernous sinus separated the ABN from the ophthalmic nerve; and (IV) immediately before the developing tendinous annulus for a common origin of extraocular recti, the ABN bent laterally to avoid a passage of the thick oculomotor nerve. Since the present observations strongly suggested morphologies at birth and in infants, major angulations of the ABN as well as the well-known course independent of the other nerves in the cavernous sinus seemed to be established during childhood. In the human body, the ABN might be a limited example showing a drastic postnatal change in course. Consequently, it might be important to know the unique course of ABN before performing endovascular interventions and skull base surgery for petroclival and cavernous sinus lesions without causing inadvertent neurovascular injuries to neonates or infants.

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Abbreviations

ABN:

Abducens nerve

CG:

Ciliary ganglion

fossa:

Middle cranial fossa

FN:

Frontal nerve;

HY:

Hypophysis

ICA:

Internal carotid artery

ICN:

Internal carotid nerve

ILT:

Inferolateral trunk of the carotid artery

IR:

Inferior rectus muscle

LR:

Lateral rectus muscle

MBN:

Mandibular nerve

MR:

Medial rectus muscle

MXN:

Maxillary nerve

OCN:

Oculomotor nerve

ON:

Optic nerve

OPA:

Ophthalmic artery

OPN:

Ophthalmic nerve

OPV:

Ophthalmic veins

ORM:

Orbitalis muscle

PSL:

Petrosphenoid ligament

SPS:

Superior petrosal sinus

sym:

Sympathetic nerve elements from the internal carotid nerve

TG:

Trigeminal ganglion

T nerve roots:

Trigeminal nerve roots

TRN:

Trochlear nerve

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Acknowledgements

This study was supported in part by a Grant-in-Aid for Scientific Research (JSPS KAKENHI No. 16K08435) from the Ministry of Education, Culture, Sports, Science and Technology in Japan.

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Authors and Affiliations

  1. Department of Anatomy, Tokyo Dental College, Tokyo, Japan

    Minako Sato, Masahito Yamamoto, Hidetomo Hirouchi, Gen Murakami & Shinichi Abe

  2. Department of Neurology, Wonkwang University School of Medicine and Hospital, Institute of Wonkwang Medical Science, 895, Muwang-ro, Iksan-si, Jeollabuk-do, 54538, Republic of Korea

    Kwang Ho Cho

  3. Division of Internal Medicine, Jikou-Kai Clinic of Home Visits, Sapporo, Japan

    Gen Murakami

  4. Department of Anatomy, Akita University School of Medicine, Akita, Japan

    Hiroshi Abe

Authors
  1. Minako Sato
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  2. Kwang Ho Cho
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  3. Masahito Yamamoto
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  4. Hidetomo Hirouchi
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  5. Gen Murakami
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  6. Hiroshi Abe
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  7. Shinichi Abe
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Contributions

MS: manuscript writing. KC: management and manuscript writing. MY: data collection and manuscript writing. HH: literature research. GM: manuscript writing and scheme drawing. HA: data collection and literature research. SA: management and literature research.

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Correspondence to Kwang Ho Cho.

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Sato, M., Cho, K.H., Yamamoto, M. et al. Cavernous sinus and abducens nerve in human fetuses near term. Surg Radiol Anat 42, 761–770 (2020). https://doi.org/10.1007/s00276-020-02443-5

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  • DOI: https://doi.org/10.1007/s00276-020-02443-5

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