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Anatomic variation of the abducens nerve in a single cadaver dissection: the “petrobasilar canal”

  • Case Report - Neurosurgical Anatomy
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Abstract

Anatomic variations of the petrosphenoid ligament, Dorello’s canal and the course of the abducens nerve have been extensively described over the past years. In the present report of a single cadaver dissection, we describe an unusual course of the abducens nerve at the level of the petrous bone. The right abducens nerve did not enter Dorello’s canal, but ran below the petrous bone through a narrow canal in the petrobasilar suture, which we called the “petrobasilar canal”. No anatomic variations of the left abducens nerve were noted.

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Acknowledgments

The authors would like to thank Drs. Hollis King, D.O. (University of California, San Diego School of Medicine, Department of Family Medicine), and Eileen Conaway, D.O., for the comments and suggestions on the paper.

Special thanks are due to Prof. Winfried Neuhuber (Institute of Anatomy, University of Erlangen, Nürnberg) for providing the opportunity to study at the Institute and for reviewing the draft and the final manuscript.

Authors’ contributions

FP and AC dissected the cadaver. FP discovered the anatomic variation. AC and FP acquired the data. GP reviewed the literature and wrote the first and second draft of the paper. All authors reviewed and approved the submission of the final manuscript.

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Authors and Affiliations

  1. Research Department, Accademia di Osteopatia e Anatomia (A.O.A.), Via Martiri della Loggia 31, 76123, Andria BT, Italy

    Felice Pizzolorusso, Andrea Cirotti & Gianfranco Pizzolorusso

  2. Research Department, Accademia Italiana Osteopatia Tradizionale – Marche (A.I.O.T. Marche), Via Einaudi 108, 62012, Civitanoma Marche MC, Italy

    Felice Pizzolorusso, Andrea Cirotti & Gianfranco Pizzolorusso

  3. Via Isonzo 16, 66100, Chieti CH, Italy

    Gianfranco Pizzolorusso

Authors
  1. Felice Pizzolorusso
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  2. Andrea Cirotti
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  3. Gianfranco Pizzolorusso
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Correspondence to Gianfranco Pizzolorusso.

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No funding was received for this research.

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Comments

The authors have to be congratulated for noticing the different (exceptional) coursing of the CNVI from the subarachnoid space in the posterior cranial fossa through the bony compartments of the apex of the pyramid into the parasellar intracavernous space. This rare variety of CNVI coursing has been mentioned before as the authors listed correctly in their text. Besides the important message this report carries, this anatomic study has several serious drawbacks. The skull base bony images are of bad quality for various reasons and do not reach the standards for publication. The old formalin-fixed specimens are below the current standards for such a study. Dissection was not microsurgical. Finally, CNVI coursing through the parasellar space—the cavernous sinus (CS)—“climbs” over the dorsal part of the medial loop of the ICA in the CS and then running along the ICA inferiorly under the infero-lateral branch of the ICA further along the horizontal segment of the ICA—in the CS—toward the superior orbital fissure (SOF). The authors should read the relevant literature and realize that there are four loops of the ICA coursing through the skull base (1). In the same publication, they will find the complete coursing of the CNVI from the posterior cranial fossa to Dorello’s space and then into the CS and further to the SOF (Figs. 1.19, 1.20, 1.22, 1.25, 1.31, 1.34–1.40, 1.44, 1.45, 1.47–1.49, 1.65).

The abbreviation used for the abducens nerve, AN, is not appropriate, since it is well accepted that cranial nerve abbreviations are according to the number of the CN. In surgeries starting in the region, the dissection of the CNVI from the brainstem (ponto-medullary junction) is superior to the information gained from preoperative MR images regarding the CNVI location.

Vinko Dolenc

Llubljana, Slovenia

References:

1.Dolenc VV (2003) Microsurgical Anatomy and Surgery of the Central Skull Base. Springer: Wien/New York.

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Pizzolorusso, F., Cirotti, A. & Pizzolorusso, G. Anatomic variation of the abducens nerve in a single cadaver dissection: the “petrobasilar canal”. Acta Neurochir 159, 677–680 (2017). https://doi.org/10.1007/s00701-017-3096-1

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