The foramen lacerum is a relevant skull base structure that has been neglected for many years. From the endoscopic endonasal perspective, the foramen lacerum is a key structure due to its location at the crossroad between the sagittal and coronal planes. The objective of this study was to provide a detailed investigation of the surgical anatomy of the foramen lacerum and its adjacent structures based on anatomical dissections and imaging studies, propose several relevant key surgical landmarks, and demonstrate the surgical technique for its full exposure with several illustrative cases.
Ten colored silicone-injected anatomical specimens were dissected using a transpterygoid approach to the foramen lacerum region in a stepwise manner. Five similar specimens were used for a comparative transcranial approach. The osseous anatomy was examined in 32 high-resolution multislice CT studies and 1 disarticulated skull. Representative cases were selected to illustrate the application of the findings.
The pterygosphenoidal fissure is the synchondrosis between the lacerum process of the pterygoid bone and the floor of the sphenoid bone. It constantly converges with the posterior end of the vidian canal at a 45° angle, and its posterolateral end points directly to the lacerum foramen. The pterygoid tubercle separates the vidian canal from the pterygosphenoidal fissure, and forms the anterior wall of the lower part of the foramen lacerum. The lingual process, which forms the lateral wall of the foramen lacerum, was identified in 53 of 64 sides and featured an average height of 5 mm. The mandibular strut separates the foramen lacerum from the foramen ovale and had an average width of 5 mm.
This study provides relevant surgical landmarks and a systematic approach to the foramen lacerum by defining anterior, medial, lateral, and inferior walls that may facilitate its safe exposure for effective removal of lesions while minimizing the risk of injury to the internal carotid artery.
Correspondence Juan C. Fernandez-Miranda: Stanford University, Palo Alto, CA. email@example.com.INCLUDE WHEN CITING Published online November 30, 2018; DOI: 10.3171/2018.6.JNS181117.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
KassamABPrevedelloDMCarrauRLSnydermanCHGardnerPOsawaS: The front door to Meckel’s cave: an anteromedial corridor via expanded endoscopic endonasal approach- technical considerations and clinical series. Neurosurgery64 (3 Suppl):ons71–ons832009
KassamAB, PrevedelloDM, CarrauRL, SnydermanCH, GardnerP, OsawaS, : The front door to Meckel’s cave: an anteromedial corridor via expanded endoscopic endonasal approach- technical considerations and clinical series. 64 (3 Suppl):ons71–ons83, 2009)| false
Pinheiro-NetoCDFernandez-MirandaJCRivera-SerranoCMPaluzziASnydermanCHGardnerPA: Endoscopic anatomy of the palatovaginal canal (palatosphenoidal canal): a landmark for dissection of the vidian nerve during endonasal transpterygoid approaches. Laryngoscope122:6–122012
Pinheiro-NetoCD, Fernandez-MirandaJC, Rivera-SerranoCM, PaluzziA, SnydermanCH, GardnerPA, : Endoscopic anatomy of the palatovaginal canal (palatosphenoidal canal): a landmark for dissection of the vidian nerve during endonasal transpterygoid approaches. 122:6–12, 2012)| false
ShinoharaALde Souza MeloCGSilveiraEMLaurisJRAndreoJCde Castro RodriguesA: Incidence, morphology and morphometry of the foramen of Vesalius: complementary study for a safer planning and execution of the trigeminal rhizotomy technique. Surg Radiol Anat32:159–1642010
ShinoharaAL, de Souza MeloCG, SilveiraEM, LaurisJR, AndreoJC, de Castro RodriguesA: Incidence, morphology and morphometry of the foramen of Vesalius: complementary study for a safer planning and execution of the trigeminal rhizotomy technique. 32:159–164, 2010)| false