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High resolution 3D magnetic resonance imaging of Gruber’s ligament: a pilot study

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A Correction to this article was published on 09 September 2022

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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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Authors and Affiliations

  1. Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St Clair Street, Chicago, IL, 60611, USA

    Marinos Kontzialis

  2. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    A. Karim Ahmed & Gary L. Gallia

  3. Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Pavlos Texakalidis

  4. Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, FL, USA

    Nafi Aygun

  5. Department of Radiology, Case Western Reserve University School of Medicine University Hospitals, Cleveland, OH, USA

    Ari M. Blitz

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  1. Marinos Kontzialis
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MK, AKA, GLG, PT, NA, and AMB wrote the main manuscript text and MK prepared figures. All authors reviewed the manuscript.

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Correspondence to Marinos Kontzialis.

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Kontzialis, M., Ahmed, A.K., Gallia, G.L. et al. High resolution 3D magnetic resonance imaging of Gruber’s ligament: a pilot study. Surg Radiol Anat 44, 1157–1163 (2022). https://doi.org/10.1007/s00276-022-02996-7

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