Grüber's ligament as a useful landmark for the abducens nerve in the transnasal approach

Ryosuke Tomio, Masahiro Toda, Agung B udi Sutiono, Takashi Horiguchi, Sadakazu Aiso, Kazunari Yoshida

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

OBJECT: Extended endoscopic transnasal surgeries for skull base lesions have recently been performed. Some expert surgeons have attempted to remove tumors such as chordomas, meningiomas, and pituitary adenomas in the clival region using the transnasal approach and have reported abducens nerve injury as a common complication. There have been many microsurgical anatomical studies of the abducens nerve, but none of these studies has described an anatomical landmark of the abducens nerve in the transnasal approach. In this study the authors used cadaver dissections to describe Grüber's ligament as the most reliable landmark of the abducens nerve in the transnasal transclival view.

METHODS: The petroclival segment of the abducens nerve was dissected in the interdural space-which is also called Dorello's canal, the petroclival venous gulf, or the sphenopetroclival venous confluence-using the transnasal approach in 20 specimens obtained from 10 adult cadaveric heads.

RESULTS: The petroclival segment of the abducens nerve clearly crossed and attached to Grüber's ligament in the interdural space, as noted in the transnasal view. The average length of the dural porus to the intersection on the abducens nerve was 5.2 ± 1.0 mm. The length of the posterior clinoid process (PCP) to the intersection on Grüber's ligament was 6.4 ± 2.6 mm. The average width of Grüber's ligament at the midsection was 1.6 ± 0.5 mm.

CONCLUSIONS: Grüber's ligament is considered a useful landmark, and it is visible in most adults. Thus, surgeons can find the abducens nerve safely by visualizing inferolaterally along Grüber's ligament from the PCP.

Original languageEnglish
Pages (from-to)499-503
Number of pages5
JournalJournal of Neurosurgery
Volume122
Issue number3
DOIs
Publication statusPublished - 2015 Mar 1

Fingerprint

Abducens Nerve
Ligaments
Abducens Nerve Injury
Chordoma
Skull Base
Pituitary Neoplasms
Meningioma
Cadaver
Dissection
Head

Keywords

  • abducens nerve
  • anatomy
  • endoscopic
  • Grüber's ligament
  • ICA = internal carotid artery
  • PCP = posterior clinoid process
  • transnasal
  • transsphenoidal

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Grüber's ligament as a useful landmark for the abducens nerve in the transnasal approach. / Tomio, Ryosuke; Toda, Masahiro; Sutiono, Agung B udi; Horiguchi, Takashi; Aiso, Sadakazu; Yoshida, Kazunari.

In: Journal of Neurosurgery, Vol. 122, No. 3, 01.03.2015, p. 499-503.

Research output: Contribution to journalArticle

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abstract = "OBJECT: Extended endoscopic transnasal surgeries for skull base lesions have recently been performed. Some expert surgeons have attempted to remove tumors such as chordomas, meningiomas, and pituitary adenomas in the clival region using the transnasal approach and have reported abducens nerve injury as a common complication. There have been many microsurgical anatomical studies of the abducens nerve, but none of these studies has described an anatomical landmark of the abducens nerve in the transnasal approach. In this study the authors used cadaver dissections to describe Gr{\"u}ber's ligament as the most reliable landmark of the abducens nerve in the transnasal transclival view.METHODS: The petroclival segment of the abducens nerve was dissected in the interdural space-which is also called Dorello's canal, the petroclival venous gulf, or the sphenopetroclival venous confluence-using the transnasal approach in 20 specimens obtained from 10 adult cadaveric heads.RESULTS: The petroclival segment of the abducens nerve clearly crossed and attached to Gr{\"u}ber's ligament in the interdural space, as noted in the transnasal view. The average length of the dural porus to the intersection on the abducens nerve was 5.2 ± 1.0 mm. The length of the posterior clinoid process (PCP) to the intersection on Gr{\"u}ber's ligament was 6.4 ± 2.6 mm. The average width of Gr{\"u}ber's ligament at the midsection was 1.6 ± 0.5 mm.CONCLUSIONS: Gr{\"u}ber's ligament is considered a useful landmark, and it is visible in most adults. Thus, surgeons can find the abducens nerve safely by visualizing inferolaterally along Gr{\"u}ber's ligament from the PCP.",
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AU - Toda, Masahiro

AU - Sutiono, Agung B udi

AU - Horiguchi, Takashi

AU - Aiso, Sadakazu

AU - Yoshida, Kazunari

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N2 - OBJECT: Extended endoscopic transnasal surgeries for skull base lesions have recently been performed. Some expert surgeons have attempted to remove tumors such as chordomas, meningiomas, and pituitary adenomas in the clival region using the transnasal approach and have reported abducens nerve injury as a common complication. There have been many microsurgical anatomical studies of the abducens nerve, but none of these studies has described an anatomical landmark of the abducens nerve in the transnasal approach. In this study the authors used cadaver dissections to describe Grüber's ligament as the most reliable landmark of the abducens nerve in the transnasal transclival view.METHODS: The petroclival segment of the abducens nerve was dissected in the interdural space-which is also called Dorello's canal, the petroclival venous gulf, or the sphenopetroclival venous confluence-using the transnasal approach in 20 specimens obtained from 10 adult cadaveric heads.RESULTS: The petroclival segment of the abducens nerve clearly crossed and attached to Grüber's ligament in the interdural space, as noted in the transnasal view. The average length of the dural porus to the intersection on the abducens nerve was 5.2 ± 1.0 mm. The length of the posterior clinoid process (PCP) to the intersection on Grüber's ligament was 6.4 ± 2.6 mm. The average width of Grüber's ligament at the midsection was 1.6 ± 0.5 mm.CONCLUSIONS: Grüber's ligament is considered a useful landmark, and it is visible in most adults. Thus, surgeons can find the abducens nerve safely by visualizing inferolaterally along Grüber's ligament from the PCP.

AB - OBJECT: Extended endoscopic transnasal surgeries for skull base lesions have recently been performed. Some expert surgeons have attempted to remove tumors such as chordomas, meningiomas, and pituitary adenomas in the clival region using the transnasal approach and have reported abducens nerve injury as a common complication. There have been many microsurgical anatomical studies of the abducens nerve, but none of these studies has described an anatomical landmark of the abducens nerve in the transnasal approach. In this study the authors used cadaver dissections to describe Grüber's ligament as the most reliable landmark of the abducens nerve in the transnasal transclival view.METHODS: The petroclival segment of the abducens nerve was dissected in the interdural space-which is also called Dorello's canal, the petroclival venous gulf, or the sphenopetroclival venous confluence-using the transnasal approach in 20 specimens obtained from 10 adult cadaveric heads.RESULTS: The petroclival segment of the abducens nerve clearly crossed and attached to Grüber's ligament in the interdural space, as noted in the transnasal view. The average length of the dural porus to the intersection on the abducens nerve was 5.2 ± 1.0 mm. The length of the posterior clinoid process (PCP) to the intersection on Grüber's ligament was 6.4 ± 2.6 mm. The average width of Grüber's ligament at the midsection was 1.6 ± 0.5 mm.CONCLUSIONS: Grüber's ligament is considered a useful landmark, and it is visible in most adults. Thus, surgeons can find the abducens nerve safely by visualizing inferolaterally along Grüber's ligament from the PCP.

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