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Occurrence of the ossification of petrosphenoid ligament: a retrospective radiologic study from computed tomographic images
, 2, 2, 3
Affiliations- Department of Anatomy, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
- Medical Imaging Department, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
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Abstract
Background: Various ligaments present in the skull base are of clinical and surgical importance. One among them, is the petrosphenoid ligament (PSL). PSL may ossify either in a partial or complete form and forms the roof of Dorello’s canal underneath which the abducens nerve passes. Studies argued both protective and adverse effects of the ossified PSL. Hence, the incidence of PSL ossification has become a relevant subject in clinical practice to radiologists, neurologists and neurosurgeons for understanding its potential role in abducens nerve compression.
Materials and methods: We have undertaken this study to investigate the incidence of PSL ossification from multidetector computed tomography (MDCT) images of the patients who had been referred to the Medical Imaging Department of Mubarak Al-Kabeer Hospital in Kuwait. We retrospectively assessed a total of 200 patients’ head CT scans (400 petroclival regions) between January 2021 and June 2022 in which 59% were males (n = 118) and 41% were females (n = 82) aged between 18 and 91 years.
Results: A total of 37 patients (26 male, 11 female) aged between 18–84 years were presented with ossification of PSL. Among these 37 patients, 28 patients were presented with unilateral ossified PSL, and 9 patients were presented with bilateral ossified PSL, amounting to the total of 46 ossified PSL from 400 CT images of the petroclival regions (11.5%). The genderwise and sidewise occurrence of the PSL ossification seen in different age groups were not statistically significant (p > 0.05). Among all the ossified cases, there was no patient presented with abducens nerve palsy.
Conclusions: We believe our results provide baseline data in the region for understanding PSL ossification and its impact on the abducens nerve palsy.
Abstract
Background: Various ligaments present in the skull base are of clinical and surgical importance. One among them, is the petrosphenoid ligament (PSL). PSL may ossify either in a partial or complete form and forms the roof of Dorello’s canal underneath which the abducens nerve passes. Studies argued both protective and adverse effects of the ossified PSL. Hence, the incidence of PSL ossification has become a relevant subject in clinical practice to radiologists, neurologists and neurosurgeons for understanding its potential role in abducens nerve compression.
Materials and methods: We have undertaken this study to investigate the incidence of PSL ossification from multidetector computed tomography (MDCT) images of the patients who had been referred to the Medical Imaging Department of Mubarak Al-Kabeer Hospital in Kuwait. We retrospectively assessed a total of 200 patients’ head CT scans (400 petroclival regions) between January 2021 and June 2022 in which 59% were males (n = 118) and 41% were females (n = 82) aged between 18 and 91 years.
Results: A total of 37 patients (26 male, 11 female) aged between 18–84 years were presented with ossification of PSL. Among these 37 patients, 28 patients were presented with unilateral ossified PSL, and 9 patients were presented with bilateral ossified PSL, amounting to the total of 46 ossified PSL from 400 CT images of the petroclival regions (11.5%). The genderwise and sidewise occurrence of the PSL ossification seen in different age groups were not statistically significant (p > 0.05). Among all the ossified cases, there was no patient presented with abducens nerve palsy.
Conclusions: We believe our results provide baseline data in the region for understanding PSL ossification and its impact on the abducens nerve palsy.
Keywords
petrosphenoid ligament, ossification, multidetector computed tomography, abducens nerve palsy
About this articleTitle
Occurrence of the ossification of petrosphenoid ligament: a retrospective radiologic study from computed tomographic images
Journal
Issue
Vol 83, No 1 (2024): Folia Morphologica
Article type
Original article
Pages
176-181
Published online
2023-01-17
Page views
432
Article views/downloads
636
DOI
Pubmed
Bibliographic record
Folia Morphol 2024;83(1):176-181.
Keywords
petrosphenoid ligament
ossification
multidetector computed tomography
abducens nerve palsy
Authors
Bhagath Kumar Potu
Fatemah Hamad Al-Khamis
Hebah Husain Taher
Abdulrahman Abdulreheim
References (31)- Aggarwal B, Gupta M, Kumar H. Ossified ligaments of the skull. J Anat Soc India. 2012; 61(1): 37–40.
- Ambekar S, Sonig A, Nanda A. Dorello's canal and Gruber's ligament: historical perspective. J Neurol Surg B Skull Base. 2012; 73(6): 430–433.
- Barges-Coll J, Fernandez-Miranda JC, Prevedello DM, et al. Avoiding injury to the abducens nerve during expanded endonasal endoscopic surgery: anatomic and clinical case studies. Neurosurgery. 2010; 67(1): 144–154.
- Chua C, Cooper LL, Wei XC, et al. Recurrent sixth nerve palsy associated with a hypoplastic Dorello's canal. J AAPOS. 2011; 15(4): 392–394.
- Clarke E, Golberg M, Smędra A, et al. Bilateral caroticoclinoid foramen and unilateral abducens nerve canal found on the fetal skull: case report. Transl Res Anat. 2022; 29: 100224.
- Destrieux C, Velut S, Kakou M, et al. A new concept in Dorello's canal microanatomy: the petroclival venous confluence. J Neurosurg. 1997; 87(1): 67–72.
- Dorello P. Considerazioni sopra la causa della paralisi transitoria dell' abducente nelle flogosi dell' orecchio medio. In: Ferrari G (ed.). Atti della Clinica Oto-Rino-Laringoiatrica. Tipografia del Campidoglio, Roma 1905: 209–217.
- Duque PJ, Barco RJ, Mendoza ZJ. Dorello´s Canal or Abducens Nerve Canal: Constancy or Inconstancy? Int J Morphol. 2017; 35(1): 233–235.
- Ezer H, Banerjee AD, Thakur JD, et al. Dorello's canal for laymen: a lego-like presentation. J Neurol Surg B Skull Base. 2012; 73(3): 183–189.
- Gruber W. Beitrage zur anatomie des keilbeins und schlafenbeins. In: Richter HE, Winter A (ed.). Schmidt's Jahrbucher der in-und Auslandischen. Gessamten Medicin, Anatomie und Physiologie. Verlag Von Otto Wigard, Leipzig 1859: 40–41.
- Iaconetta G, Tessitore E, Samii M. Duplicated abducent nerve and its course: microanatomical study and surgery-related considerations. J Neurosurg. 2001; 95(5): 853–858.
- Icke C, Ozer E, Arda N. Microanatomical characteristics of the petrosphenoidal ligament of gruber. Turk Neurosurg. 2010; 20(3): 323–327.
- Inal M, Muluk NB, Burulday V, et al. Investigation of the calcification at the petroclival region through multi-slice computed tomography of the skull base. J Craniomaxillofac Surg. 2016; 44(4): 347–352.
- Joo W, Yoshioka F, Funaki T, et al. Microsurgical anatomy of the abducens nerve. Clin Anat. 2012; 25(8): 1030–1042.
- Kshettry VR, Lee JH, Ammirati M. The Dorello canal: historical development, controversies in microsurgical anatomy, and clinical implications. Neurosurg Focus. 2013; 34(3): E4.
- Liu XD, Xu QW, Che XM, et al. Anatomy of the petrosphenoidal and petrolingual ligaments at the petrous apex. Clin Anat. 2009; 22(3): 302–306.
- Marom A. A new look at an old canal. Skull Base. 2011; 21(1): 53–58.
- Nathan H, Ouaknine G, Kosary IZ. The abducens nerve. Anatomical variations in its course. J Neurosurg. 1974; 41(5): 561–566.
- Ozer E, Icke C, Arda N. Microanatomical study of the intracranial abducens nerve: clinical interest and surgical perspective. Turk Neurosurg. 2010; 20(4): 449–456.
- Özgür A, Esen K. Ossification of the petrosphenoidal ligament: multidetector computed tomography findings of an unusual variation with a potential role in abducens nerve palsy. Jpn J Radiol. 2015; 33(5): 260–265.
- Ozveren MF, Erol FS, Alkan A, et al. Microanatomical architecture of Dorello's canal and its clinical implications. Neurosurgery. 2007; 60(2 Suppl 1): 1–7.
- Peker T, Anil A, Gülekon N, et al. The incidence and types of sella and sphenopetrous bridges. Neurosurg Rev. 2006; 29(3): 219–223.
- Rusu MC, Vrapciu AD, Rădoi PM, et al. Concomitant completely ossified trigeminal pore and Dorello’s canal. Folia Morphol. 2023; 82(1): 187–189.
- Skrzat J, Mróz I, Spulber A, et al. Ossification of the petrosphenoid ligament: a case study. Folia Med Cracov. 2017; 57(2): 87–94.
- Tomio R, Toda M, Sutiono AB, et al. Grüber's ligament as a useful landmark for the abducens nerve in the transnasal approach. J Neurosurg. 2015; 122(3): 499–503.
- Touska P, Hasso S, Oztek A, et al. Skull base ligamentous mineralisation: evaluation using computed tomography and a review of the clinical relevance. Insights Imaging. 2019; 10(1): 55.
- Tsitsopoulos PD, Tsonidis CA, Petsas GP, et al. Microsurgical study of the Dorello's canal. Skull Base Surg. 1996; 6(3): 181–185.
- Tubbs RS, Sharma A, Loukas M, et al. Ossification of the petrosphenoidal ligament: unusual variation with the potential for abducens nerve entrapment in Dorello's canal at the skull base. Surg Radiol Anat. 2014; 36(3): 303–305.
- Umansky F, Elidan J, Valarezo A. Dorello's canal: a microanatomical study. J Neurosurg. 1991; 75(2): 294–298.
- Wysiadecki G, Orkisz S, Gałązkiewicz-Stolarczyk M, et al. The abducens nerve: its topography and anatomical variations in intracranial course with clinical commentary. Folia Morphol. 2015; 74(2): 236–244.
- Żytkowski A, Clarke E, Musiał A, et al. Atypical attachment of the petrosphenoidal (petroclival) ligament to the posterior genu of the cavernous internal carotid artery: case report. Transl Res Anat. 2022; 27: 100185.
