Regional vascular relationships to the foramen ovale: an anatomical study with application to approaches to the external skull base with an emphasis on transcutaneous procedures for the treatment of trigeminal neuralgia

Laboratory investigation

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Object

The foramen ovale and its neighboring vascular structures may be seen via external approaches to the skull base. More commonly, however, transcutaneous approaches to the foramen ovale are performed. Although complications with this latter technique are uncommon, studies of the distances to the surrounding extracranial vascular structures are lacking in the literature. The present study aimed to elucidate such anatomical relationships.

Methods

Twenty adult cadavers (40 sides) underwent dissection of the region surrounding the foramen ovale at the external skull base. Measurements between the external surface of the foramen ovale and surrounding vascular structures were made.

Results

From the nearest aspect of the undersurface of the foramen ovale, the authors found that the mean distances to the middle meningeal artery, maxillary artery, superior bulb of the internal jugular vein, and internal carotid artery at its entrance to and exit from the carotid canal were 3, 19, 20, 9, and 12 mm, respectively. Distances tended to be shorter in females, but this did not reach statistical significance. On the basis of these data, the authors also determined a safe zone while approaching the undersurface of the foramen ovale.

Conclusions

Additional knowledge of the neurovascular relationships surrounding the foramen ovale may be useful to the neurosurgeon and may help decrease the potential for complications.

Abbreviations used in this paper: ICA = internal carotid artery; MMA = middle meningeal artery.

Article Information

Address correspondence to: R. Shane Tubbs, Ph.D., Pediatric Neurosurgery, Children's Hospital, 1600 7th Avenue South, ACC 400, Birmingham, Alabama 35233. email: rstubbs@uab.edu.

Please include this information when citing this paper: published online March 19, 2010; DOI: 10.3171/2010.3.JNS091454.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Schematic drawing (lateral view) of the skull base neurovascular relationships as noted in the present study.

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    Schematic drawing (anterior view) of the skull base illustrating the vascular relationships of the right foramen ovale.

  • View in gallery

    Radiograph, as used during transcutaneous approaches for trigeminal neuralgia, demonstrating the left foramen ovale (within dotted circle). Note the approximate locations of the internal jugular vein (blue) and ICA (red) in relation to the foramen ovale.

  • View in gallery

    Skull base photograph showing the safe and danger zones near the left foramen ovale.

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