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Anterior Brainstem After Clival Drilling

Surgical Correlation

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Anterior coronal view of the brainstem following removal of clivus. Portions of the sphenoid bone remain that demonstrate the apex of the orbits and associated contents, the greater wings containing the temporal lobes, the foramen rotundum for the maxillary nerve, and pterygoid (Vidian) canal for the pterygoid (Vidian) nerve. The abducens nerve is seen coursing from the anterior surface of the pons to the superior orbital fissure. The glossopharyngeal, vagus, and cranial roots of the spinal accessory nerves arise from the lateral aspect of the medulla in a rostral-caudal sequence and course toward the jugular foramen. The hypoglossal nerves also arise from the medulla and are seen here traversing intact hypoglossal canals. (Image courtesy of AL Rhoton, Jr.)

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