Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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A Case of Aberrant Abducens Nerve in a Cadaver and Review of Its Clinical Significance

  • Choi, Chan-Young (Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University) ;
  • Han, Seong-Rok (Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University) ;
  • Yee, Gi-Taek (Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University) ;
  • Lee, Chae-Heuck (Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University)
  • Received : 2010.01.19
  • Accepted : 2010.03.22
  • Published : 2010.05.28
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Abstract

The abducens nerve usually travels from the brainstem to the lateral rectus muscle as a single trunk. However, it has been reported that this nerve could split into branches occasionally. We attempted to show the aberrant course of abducens nerve in a specimen with unilateral duplicated abducens nerve and review relevant literatures. The micro-dissections were performed in a head specimen injected with colored latex under the microscope. The abducens nerve was duplicated unilaterally. This nerve emerged from the pontomedullary sulcus as a single trunk and splitted into two branches in the prepontine cistern. These two separate branches were piercing the cerebral dura of the petroclival region respectively. The slender lower branch passed between the petroclinoid and petrosphenoid ligaments and the thick lower one passed under the petrosphenoid ligament. These two branches united just lateral to the ascending segment of internal carotid artery in the cavernous sinus. The fact that there are several types of aberrant abducens nerve is helpful to perform numerous neurosurgical procedures in the petroclival region and cavernous sinus without inadvertent neurovascular injuries.

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References

  1. 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 87 : 67-72, 1997 https://doi.org/10.3171/jns.1997.87.1.0067
  2. Fukushima T, Day JD, Hirahara K : Extradural total petrous apex resection with trigeminal translocation for improved exposure of the posterior cavernous sinus and petroclival region. Skull Base Surg 6 : 95-103, 1996 https://doi.org/10.1055/s-2008-1058650
  3. Halbach VV, Higashida RT, Hieshima GB, Hardin CW, Yang PJ : Transvenous embolization of direct carotid cavernous fistulas. AJNR Am J Neuroradiol 9 : 741-747, 1988
  4. Iaconetta G, Fusco M, Cavallo LM, Cappabianca P, Samii M, Tschabitscher M : The abducens nerve : microanatomic and endoscopic study. Neurosurgery 61 : 7-14; discussion 14, 2007 https://doi.org/10.1227/01.neu.0000289706.42061.19
  5. Iaconetta G, Tessitore E, Samii M : Duplicated abducent nerve and its course : microanatomical study and surgery-related considerations. J Neurosurg 95 : 853-858, 2001 https://doi.org/10.3171/jns.2001.95.5.0853
  6. Jain KK : Aberrant roots of the abducents nerve. J Neurosurg 21 : 349-351, 1964 https://doi.org/10.3171/jns.1964.21.5.0349
  7. Kawase T, Shiobara R, Toya S : Anterior transpetrosal-transtentorial approach for sphenopetroclival meningiomas : surgical method and results in 10 patients. Neurosurgery 28 : 869-875; discussion 875-876, 1991 https://doi.org/10.1227/00006123-199106000-00014
  8. Nathan H, Ouaknine G, Kosary IZ : The abducens nerve. Anatomical variations in its course. J Neurosurg 41 : 561-566, 1974 https://doi.org/10.3171/jns.1974.41.5.0561
  9. Ozveren MF, Sam B, Akdemir I, Alkan A, Tekdemir I, Deda H : Duplication of the abducens nerve at the petroclival region : an anatomic study. Neurosurgery 52 : 645-652; discussion 651-652, 2003 https://doi.org/10.1227/01.NEU.0000048186.18741.3C
  10. Ozveren MF, Uchida K, Aiso S, Kawase T : Meningovenous structures of the petroclival region : clinical importance for surgery and intravascular surgery. Neurosurgery 50 : 829-836; discussion 836-837, 2002 https://doi.org/10.1097/00006123-200204000-00027
  11. Ozveren MF, Uchida K, Erol FS, Tiftikci MT, Cobanoglu B, Kawase T : Isolated abducens nerve paresis associated with incomplete Horner's syndrome caused by petrous apex fracture--case report and anatomical study. Neurol Med Chir (Tokyo) 41 : 494-498, 2001 https://doi.org/10.2176/nmc.41.494
  12. Ozveren MF, Uchida K, Tekdemir I, Cobanoglu B, Akdemir I, Kawase T, et al. : Dural and arachnoid membraneous protection of the abducens nerve at the petroclival region. Skull Base 12 : 181-188, 2002 https://doi.org/10.1055/s-2002-35749-1
  13. Tillack TW, Winer JA : Anomaly of the abducens nerve. Yale J Biol Med 34 : 620-624, 1962
  14. Tsitsopoulos PD, Tsonidis CA, Petsas GP, Hadjiioannou PN, Njau SN, Anagnostopoulos IV : Microsurgical Study of the Dorello's Canal. Skull Base Surg 6 : 181-185, 1996 https://doi.org/10.1055/s-2008-1058643
  15. Umansky F, Valarezo A, Elidan J : The microsurgical anatomy of the abducens nerve in its intracranial course. Laryngoscope 102 : 1285-1292, 1992 https://doi.org/10.1288/00005537-199211000-00016
  16. Vail RL : Anatomical studies of Dorello's canal. Laryngoscope 32 : 569-575, 1922
  17. Weninger WJ, Müller G : The parasellar region of human infants : cavernous sinus topography and surgical approaches. J Neurosurg 90 : 484-490, 1999 https://doi.org/10.3171/jns.1999.90.3.0484
  18. Williams P, Warwick R : Gray's Anatomy (ed 36). Edinburgh : Churchill Livingstone, 1980
  19. Ziyal IM, Salas E, Wright DC, Sekhar LN : The petrolingual ligament : the anatomy and surgical exposure of the posterolateral landmark of the cavernous sinus. Acta Neurochir (Wien) 140 : 201- 204; discussion 204-205, 1998 https://doi.org/10.1007/s007010050086