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: The foramen lacerum (FL), located at the base of the skull, is generally considered the safest anatomical pathway for accessing the internal carotid artery (ICA) and the vidian canal (VC) during surgical procedures. We aimed to evaluate the morphometric characteristics of FL, VC, and related structures. This study utilized cranial computed tomography (CT) images obtained between 2016 and 2018 at Balıkesir University Faculty of Medicine for various clinical indications. A retrospective analysis was performed on cranial CT images from 77 patients, comprising 42 females and 35 males. The length and width of the FL, the length of the VC, and the angles formed between the VC and the pterygosphenoidal fissure and between the VC and the palatovaginal canal were measured. All measurements were performed using the three-dimensional (3D) Slicer software to ensure precision and consistency. : Males had significantly longer right and left FL lengths and left FL width than females ( < 0.05). No significant gender-based differences were found in VC length on either side. The angle between the VC and the pterygosphenoidal fissure was significantly larger in males ( < 0.05). Additionally, increased FL length and width were significantly correlated with larger angles between the VC and the pterygosphenoidal fissure in all subjects ( < 0.05). The anatomical variations of the FL Type 1 (normal) were identified as the most prevalent configuration across the study population. Type 2 (canal-shaped) ranked as the second most frequent variant in females, whereas Type 3 (bridged) was the second most commonly observed form in males. : Preoperative identification of FL anatomical variations, which differ between individuals and sexes, may enhance the safety of skull base surgeries and minimize postoperative complications. The morphometric data presented in this study provide valuable guidance for clinicians planning interventions involving the FL and surrounding structures, and contribute valuable insights to anatomists regarding regional morphology.
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http://dx.doi.org/10.3390/medicina61050943 | DOI Listing |
Medicina (Kaunas)
May 2025
Department of Anatomy, Faculty of Medicine, Sanko University, Gaziantep 27090, Türkiye.
: The foramen lacerum (FL), located at the base of the skull, is generally considered the safest anatomical pathway for accessing the internal carotid artery (ICA) and the vidian canal (VC) during surgical procedures. We aimed to evaluate the morphometric characteristics of FL, VC, and related structures. This study utilized cranial computed tomography (CT) images obtained between 2016 and 2018 at Balıkesir University Faculty of Medicine for various clinical indications.
View Article and Find Full Text PDFJ Neurol Surg B Skull Base
August 2024
Department of Neurosurgery, Stanford Hospital, Stanford, California, United States.
The endoscopic endonasal approach has emerged as an excellent option for the treatment of lesions involving the petroclival fissure (PCF). Here, we investigate the surgical anatomy of the ventral PCF and its application in endoscopic endonasal surgery. Sixteen head specimens were used to investigate the anatomical features of PCF and relevant technical nuances in translacerum, extreme medial, and contralateral transmaxillary (CTM) approaches.
View Article and Find Full Text PDFOper Neurosurg
March 2024
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA.
Background And Objectives: Triangular corridors have been used as reliable surgical entry points for open transcranial approaches to the petrous apex (PA) and petroclival region (PCR). The endoscopic endonasal approaches have grown rapidly in the last decade, and the indications have advanced. The knowledge of accurate and reliable anatomic landmarks through endoscopic endonasal route is essential and remain to be established.
View Article and Find Full Text PDFJ Neurol Surg B Skull Base
October 2024
Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States.
The clival, paraclival, and craniocervical junction regions are challenging surgical targets. To approach these areas, endoscopic endonasal transclival approaches (EETCAs) and their extensions (far-medial approach and odontoidectomy) have gained popularity as they obviate manipulating and working between neurovascular structures. Although several cadaveric studies have further refined these contemporary approaches, few provide a detailed step-by-step description.
View Article and Find Full Text PDFOper Neurosurg
June 2023
Department of Neurosurgery, Stanford Hospital, Stanford, California, USA.
Background: Safe exposure of the lacerum segment of the carotid artery remains a challenge in endoscopic endonasal surgery.
Objective: To introduce the pterygosphenoidal triangle as a novel and reliable landmark for facilitating access to the foramen lacerum.
Methods: Fifteen colored silicone-injected anatomic specimens were dissected using an endoscopic endonasal approach to the foramen lacerum region in a stepwise manner.