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Coronal Section of the Skull Base Through the Orbital Apex

Surgical Correlation


Coronal section of the skull base through the orbital apex with view of the posterior fossa through the clivus. The foramina of the skull base anterior to the cavernous sinus include the foramen rotundum, through which V2 passes, and the pterygoid canal (Vidian canal) through which the neurovasculature of the pterygoid canal passes. Both lead to the pterygopalatine fossa for distribution to the orbit, face, nasal cavity, and palate. The Vidian nerve contains fibers from the greater superficial petrosal and the deep petrosal nerves. The Eustachian tubes (retracted) connect the nasopharynx to the middle ear and run from a posterolateral to an anteromedial direction. Windows made through the clivus expose the ventral posterior fossa where the vertebral arteries unite to form the basilar artery. The abducens nerve ascends from the medial pontomedullary junction to Dorello’s canal, through the cavernous sinus on the lateral surface of the internal carotid artery, and to the orbital apex. Glossopharyngeal, vagus, and spinal accessory nerves are in view leaving the lateral medulla and coursing toward the jugular foramen, and the hypoglossal nerve is seen traversing the hypoglossal canal into the neck.  (Image courtesy of AL Rhoton, Jr.)