Skip to main content

Advertisement

Log in

Unilateral duplicated abducens nerve coursing through both the sphenopetroclival venous gulf and cavernous sinus: a case report

  • Anatomic Variations
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

A Correction to this article was published on 28 August 2018

This article has been updated

Abstract

In this anatomy report, we describe the first case of abducens nerve duplication limited to the sphenopetroclival venous gulf and the cavernous sinus. The objective point of division of the two duplicated roots was localized at the gulfar face of the dural porus, just distal to the unique cisternal trunk of the abducens nerve, as it pierced the petroclival dural mater. In the gulfar segment, both roots traveled through a variant of Dorello’s canal called the “petrosphenoidal canal” and remained separated through the posterior half of the cavernous sinus. Both roots finally fused in the anterior half of the cavernous sinus to innervate the lateral rectus muscle as a single trunk. Although many variants of the abducens nerve have been reported over the recent decades, this anatomic variation has never been previously described and enriches the continuum of abducens nerve variations reported in the literature data. Awareness of this variation is crucial for neurosurgeons, especially during clival or petrosal surgical approaches used for resection of skull base chordomas.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

Change history

  • 28 August 2018

    In the Original Publication of the article, one of the references was missed to include. This reference and the text citation are given below.

References

  1. Arias MJ (1985) Bilateral traumatic abducens nerve palsy without skull fracture and with cervical spine fracture: case report and review of the literature. Neurosurgery 16:232–234

    Article  PubMed  CAS  Google Scholar 

  2. Baidoo EA, Tubbs RS (2015) Anatomy of the abducens nerve. In: Tubbs RS, Rizk E, Shoja M, Loukas M, Spinner RJ, Barbaro N (eds) Nerves and nerve injuries. vol 1: history, embryology, anatomy, imaging, and diagnostics, 1st edn. Elsevier, London, pp 351–356

    Google Scholar 

  3. Berlit P, Berg-Dammer E, Kuehne D (1997) Abducens nerve palsy in spontaneous intracranial hypotension. Neurology 44:1552

    Article  Google Scholar 

  4. Destrieux C, Velut S, Kakou MK, Lefrancq T, Arbeille B, Santini JJ (1997) A new concept in Dorello’s canal microanatomy: the petroclival venous confluence. J Neurosurg 87:67–72

    Article  PubMed  CAS  Google Scholar 

  5. Dorello P (1905) Considerazioni sopra la causa della paralisi transitoria dell’abducente nelle flogosi dell’orecchio medio [in Italian]. In: Ferreri G (ed) Atti Della Clinica Oto-Rino-Laringoiatrica. Tipografia del Campidoglio, Roma, pp 209–217

    Google Scholar 

  6. Gruber W (1859) Beiträge zur Anatomie des Keilbeins und Schläfenbeins [in German]. In: Richter HE, Winter A (eds) Schmidt’s Jahrbücher der In- und Ausländischen Gesammten Medicin. II. Anatomie und Physiologie. Von Otto Wigard, Leipzig

    Google Scholar 

  7. Iaconetta G, Fusco M, Cavallo LM, Cappabianca P, Samii M, Tschabitscher M (2007) The abducens nerve: microanatomic and endoscopic study. Neurosurgery 61:7–14

    PubMed  Google Scholar 

  8. Iaconetta G, Tessitore E, Samii M (2001) Duplicated abducens nerve and its course: microanatomical study and surgery-related considerations. J Neurosurg 95:853–858

    Article  PubMed  CAS  Google Scholar 

  9. Icke C, Ozer E, Arda N (2010) Microanatomical characteristics of the petrosphenoidal ligament of Gruber. Turk Neurosurg 20:323–327

    PubMed  Google Scholar 

  10. Jain KK (1964) Aberrant roots of the abducens nerve. J Neurosurg 21:349–351

    Article  PubMed  CAS  Google Scholar 

  11. Joo W, Yoshioka F, Funaki T, Rhoton AL Jr. (2012) Microsurgical anatomy of the abducens nerve. Clin Anat 25:1030–1042

    Article  PubMed  Google Scholar 

  12. Kshettry VR, Lee JH, Ammirati M (2013) The Dorello canal: historical development, controversies in microsurgical anatomy, and clinical implications. Neurosurg Focus 34:E4

    Article  PubMed  Google Scholar 

  13. Liu XD, Xu QW, Che XM, Mao RL (2009) Anatomy of the petrosphenoidal and petrolingual ligaments at the petrous apex. Clin Anat 22:302–306

    Article  PubMed  Google Scholar 

  14. Maitland CG, Black JL, Smith WA (1983) Abducens nerve palsy due to spontaneous dissection of the internal carotid artery. Arch Neurol 40:448–449

    Article  PubMed  CAS  Google Scholar 

  15. Nathan H, Ouaknine G, Kosary IZ (1974) The abducens nerve: anatomical variations in its course. J Neurosurg 41:561–566

    Article  PubMed  CAS  Google Scholar 

  16. Ozveren MF, Sam B, Akdemir I, Alkan A, Tekdemir I, Deda H (2003) Duplication of the abducens nerve at the petroclival region: an anatomic study. Neurosurgery 52:645–652

    Article  PubMed  Google Scholar 

  17. Peng M, Poukens V, da Silva Costa RM, Yoo L, Tychsen L, Demer JL (2010) Compartmentalized innervation of primate lateral rectus muscle. Invest Ophthalmol Vis Sci 51:4612–4617

    Article  PubMed  PubMed Central  Google Scholar 

  18. Schneider RC, Johnson FD (1971) Bilateral traumatic abducens palsy. A mechanism of injury suggested by the study of associated cervical spine fractures. J Neurosurg 34:33–37

    Article  PubMed  CAS  Google Scholar 

  19. Summers CG, Wirtschafter JD (1979) Bilateral trigeminal and abducens neuropathies following low-velocity, crushing head injury. Case report. J Neurosurg 50:508–511

    Article  PubMed  CAS  Google Scholar 

  20. Taniguchi M, Kohmura E (2012) Endoscopic endonasal removal of laterally extended clival chordoma using side-viewing scopes. Acta Neurochir (Wien) 154:627–632

    Article  Google Scholar 

  21. Tsitsopoulos PD, Tsonidis CA, Petsas GP, Hadjiioannou PN, Njau SN, Anagnostopoulos IV (1996) Microsurgical study of the Dorello’s canal. Skull Base Surg 6:181–185

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Umansky F, Valarezo A, Elidan J (1992) The microsurgical anatomy of the abducens nerve in its intracranial course. Laryngoscope 102:1285–1292

    Article  PubMed  CAS  Google Scholar 

  23. Zhang Y, Yu H, Shen BY, Zhong CJ, Liu EZ, Lin YZ, Jing GH (2012) Microsurgical anatomy of the abducens nerve. Surg Radiol Anat 34:3–14

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to express our gratitude to all donors to the anatomy laboratory.

Author information

Authors and Affiliations

Authors

Contributions

TC: project development, data collection, data analysis, manuscript writing and editing. ML, MD, PhD: project development, data analysis, manuscript writing and editing. LC, MD: project development, data analysis, manuscript editing. PF, MD: project development, data analysis, manuscript editing. ÉH, MD, PhD: project development, data analysis, manuscript editing. JP, MD, PhD: project development, data collection, data analysis, manuscript writing and editing.

Corresponding author

Correspondence to Thomas Coquet.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Coquet, T., Lefranc, M., Chenin, L. et al. Unilateral duplicated abducens nerve coursing through both the sphenopetroclival venous gulf and cavernous sinus: a case report. Surg Radiol Anat 40, 835–840 (2018). https://doi.org/10.1007/s00276-018-2003-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00276-018-2003-7

Keywords

Navigation