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Anterior View of Clival Region

Surgical Correlation

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Anterior transcranial coronal view with exposure of structures in the clival region. The pharyngotympanic tubes and internal carotid arteries are reflected to reveal the petrous portions of the temporal bone and openings of the hypoglossal canals. The pterygoid processes have also been removed. Several key structures are revealed in this perspective. Beginning superiorly in the midline, the pituitary gland rests in the sella turcica. Lateral to this are the optic canals transmitting the optic nerve and ophthalmic artery to the apices of the orbits. The abducens nerve can be seen in its course into the superior orbital fissure. Along the body of the sphenoid are the cavernous segments of the internal carotid artery and the petrous segments are also exposed bilaterally. Windows in the clivus expose the vertebral and basilar arteries anterior to the medulla and pons, respectively. The glossopharyngeal, vagus, and spinal accessory nerves are shown emerging from the jugular foramen. The hypoglossal canal transmits the hypoglossal nerve. The maxillary nerve and nerve of the pterygoid canal can be seen traversing their bony canals to enter the posterior wall of the pterygopalatine fossa. (Image courtesy of AL Rhoton, Jr.)

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