Grüber's ligament as a useful landmark for the abducens nerve in the transnasal approach.
OBJECTIVE
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.
Departments of Neurosurgery and.
Ryosuke
R
Tomio
Masahiro
M
Toda
Agung Budi
AB
Sutiono
Takashi
T
Horiguchi
Sadakazu
S
Aiso
Kazunari
K
Yoshida
D000010:Abducens Nerve / Q000033:anatomy & histology* / Q000601:surgery*; D059925:Anatomic Landmarks / Q000033:anatomy & histology*; D002102:Cadaver; D006801:Humans; D008022:Ligaments / Q000033:anatomy & histology* / Q000601:surgery*; D009296:Nasal Cavity / Q000033:anatomy & histology* / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D013101:Sphenoid Sinus / Q000033:anatomy & histology
Grüber's ligament; ICA = internal carotid artery; PCP = posterior clinoid process; abducens nerve; anatomy; endoscopic; transnasal; transsphenoidal