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J Neurol Surg B Skull Base 2020; 81(06): 603-609
DOI: 10.1055/s-0039-1692699
Original Article

The Petroclinoid Ligament: Its Morphometrics, Relationships, Variations, and Suggestion for New Terminology

Joe Iwanaga
1   Seattle Science Foundation, Seattle, Washington, United States
2   Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Japan
,
Juan J. Altafulla
1   Seattle Science Foundation, Seattle, Washington, United States
3   Swedish Medical Center, Swedish Neuroscience Institute, Seattle, Washington, United States
4   Department of Neurosurgery, Hospital Santo Tomas, Panama City, Panama
,
Santiago Gutierrez
1   Seattle Science Foundation, Seattle, Washington, United States
,
Graham Dupont
1   Seattle Science Foundation, Seattle, Washington, United States
,
Koichi Watanabe
2   Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Japan
,
Zachary Litvack
3   Swedish Medical Center, Swedish Neuroscience Institute, Seattle, Washington, United States
,
R. Shane Tubbs
1   Seattle Science Foundation, Seattle, Washington, United States
5   Department of Anatomical Sciences, St. George's University, St. George, Grenada
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Abstract

The anatomy and definition of the petroclinoid ligament (PCL) and its relationship with the abducens nerve are variably described. The goal of this study was to clarify the anatomy of the PCL and better elucidate its relationship with the abducens nerve. Thirty-six sides from 18 fresh-frozen adult cadaveric heads were used in this study. Specimens were all Caucasian and derived from 10 males and 8 females. The mean age at death was 79 years. Dissection of the PCL and abducens nerve was performed using a surgical microscope. The anterior and posterior attachments of the PCL, and position of the abducens nerve were noted. Subsequently, the width, thickness, and length of the ligament, and diameter of the abducens nerve were measured. Thirty-one sides (86.1%) were found to have a PCL, on two sides (5.6%), the PCL was ossified, and on three sides (8.3%), the PCL was absent. The width, thickness, and length of the PCL ranged from 0.54 to 3.39, 0.07 to 0.49, and 3.27 to 17.85 mm, respectively. No PCL had an anterior attachment onto the posterior clinoid process but rather, the clivus. Therefore, based on our findings, the PCL would be better described as the petroclival ligament.

Keywords

clivus - sinus - basilar - clinoid process - anatomy - cadaver - ligament


Publication History

Received: 12 February 2019

Accepted: 11 May 2019

Article published online:
24 July 2019

© 2020. Thieme. All rights reserved.

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  • References

  • 1 Gruber W. Beiträge zur Anatomie des Keilbeines und Schläfenbeines. 1859 : na
    PubMedGoogle Scholar
  • 2 Wysiadecki G, Haladaj R, Polgulj M, Zytkowski A, Topol M. Bilateral Extensive Ossification of the Posterior Petroclinoid Ligament: An Anatomical Case Report and Literature Review. J Neurol Surg A Cent Eur Neurosurg 2018
    PubMedGoogle Scholar
  • 3 Icke C, Ozer E, Arda N. Microanatomical characteristics of the petrosphenoidal ligament of Gruber. Turk Neurosurg 2010; 20 (03) 323-327
    PubMedGoogle Scholar
  • 4 Umansky F, Elidan J, Valarezo A. Dorello's canal: a microanatomical study. J Neurosurg 1991; 75 (02) 294-298
    CrossrefPubMedGoogle Scholar
  • 5 Alturki A, Enriquez-Marulanda A, Gupta R, Thomas AJ, Ogilvy CS. Microsurgical resection of a meningioma at the entrance of Dorello's canal causing VI cranial nerve compression: 2-dimensional operative video. Oper Neurosurg (Hagerstown) 2019; 16 (01) E8
    CrossrefPubMedGoogle Scholar
  • 6 Felisati D, Sperati G. Gradenigo's syndrome and Dorello's canal. Acta Otorhinolaryngol Ital 2009; 29 (03) 169-172
    PubMedGoogle Scholar
  • 7 Chua C, Cooper LL, Wei XC, Ruddell S. Recurrent sixth nerve palsy associated with a hypoplastic Dorello's canal. J AAPOS 2011; 15 (04) 392-394
    CrossrefPubMedGoogle Scholar
  • 8 Kshettry VR, Lee JH, Ammirati M. The Dorello canal: historical development, controversies in microsurgical anatomy, and clinical implications. Neurosurg Focus 2013; 34 (03) E4
    CrossrefPubMedGoogle Scholar
  • 9 Destrieux C, Velut S, Kakou MK, Lefrancq T, Arbeille B, Santini JJ. A new concept in Dorello's canal microanatomy: the petroclival venous confluence. J Neurosurg 1997; 87 (01) 67-72
    CrossrefPubMedGoogle Scholar
  • 10 Standring S. Gray's Anatomy: The Anatomical Basis of Clinical Practice. London: Elsevier Health Sciences; 2015
    Google Scholar
  • 11 Skrzat J, Walocha J, Jaworek JK, Mróz I. The clinical significance of the petroclinoid ligament. Folia Morphol (Warsz) 2007; 66 (01) 39-43
    PubMedGoogle Scholar
  • 12 Kimball D, Kimball H, Matusz P, Tubbs RS, Loukas M, Cohen-Gadol AA. Ossification of the posterior petroclinoid dural fold: a cadaveric study with neurosurgical significance. J Neurol Surg B Skull Base 2015; 76 (04) 272-277
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Gradenigo G. Über die paralyse des nervus abducens bei otitis. J Archiv für Ohrenheilkunde 1907; 74 (01) 149-187
    CrossrefPubMedGoogle Scholar
  • 14 Lang J. Skull Base and Related Structures: Atlas of Clinical Anatomy. Stuttgart, Germany: Schattauer Verlag; 2001
    Google Scholar
  • 15 Ambekar S, Sonig A, Nanda A. Dorello's canal and Gruber's ligament: historical perspective. J Neurol Surg B Skull Base 2012; 73 (06) 430-433
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Mittal SO, Siddiqui J, Katirji B. Abducens nerve palsy due to inferior petrosal sinus thrombosis. J Clin Neurosci 2017; 40: 69-71
    CrossrefPubMedGoogle Scholar
  • 17 Tomio R, Toda M, Sutiono AB, Horiguchi T, Aiso S, Yoshida K. Grüber's ligament as a useful landmark for the abducens nerve in the transnasal approach. J Neurosurg 2015; 122 (03) 499-503
    CrossrefPubMedGoogle Scholar
  • 18 Liu XD, Xu QW, Che XM, Mao RL. Anatomy of the petrosphenoidal and petrolingual ligaments at the petrous apex. Clin Anat 2009; 22 (03) 302-306
    CrossrefPubMedGoogle Scholar
  • 19 Reddy RK, Reddy RK, Jyung RW, Eloy JA, Liu JK. Gruber, Gradenigo, Dorello, and Vail: key personalities in the historical evolution and modern-day understanding of Dorello's canal. J Neurosurg 2016; 124 (01) 224-233
    CrossrefPubMedGoogle Scholar
  • 20 Yasuda A, Campero A, Martins C, Rhoton Jr AL, de Oliveira E, Ribas GC. Microsurgical anatomy and approaches to the cavernous sinus. Neurosurgery 2005; 56 (1, Suppl): 4-27, discussion 4–27
    CrossrefPubMedGoogle Scholar
  • 21 Marom A. A new look at an old canal. Skull Base 2011; 21 (01) 53-58
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Inal M, Muluk NB, Burulday V. et al. Investigation of the calcification at the petroclival region through multi-slice computed tomography of the skull base. J Craniomaxillofac Surg 2016; 44 (04) 347-352
    CrossrefPubMedGoogle Scholar
  • 23 Tubbs RS, Sharma A, Loukas M, Cohen-Gadol AA. Ossification of the petrosphenoidal ligament: unusual variation with the potential for abducens nerve entrapment in Dorello's canal at the skull base. Surg Radiol Anat 2014; 36 (03) 303-305
    CrossrefPubMedGoogle Scholar
  • 24 Özgür A, Esen K. Ossification of the petrosphenoidal ligament: multidetector computed tomography findings of an unusual variation with a potential role in abducens nerve palsy. Jpn J Radiol 2015; 33 (05) 260-265
    CrossrefPubMedGoogle Scholar
  • 25 Cederberg RA, Benson BW, Nunn M, English JD. Calcification of the interclinoid and petroclinoid ligaments of sella turcica: a radiographic study of the prevalence. Orthod Craniofac Res 2003; 6 (04) 227-232
    CrossrefPubMedGoogle Scholar
  • 26 Natsis K, Piagkou M, Lazaridis N, Totlis T, Anastasopoulos N, Constantinidis J. Incidence and morphometry of sellar bridges and related foramina in dry skulls: their significance in middle cranial fossa surgery. J Craniomaxillofac Surg 2018; 46 (04) 635-644
    CrossrefPubMedGoogle Scholar