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Dissection of Right Petrous Temporal and Greater Wing of Sphenoid Bones

Surgical Correlation

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Dissection of right petrous temporal and greater wing of sphenoid bones. The cerebrum has been dissected away to expose the brainstem and cerebellum in situ. The middle cranial fossa is the lateral depression between the lesser wing of the sphenoid and petrous portion of the temporal bone. The dura mater has been stripped from the lateral surface of the sphenoid body and greater wing and a portion of the greater wing has been drilled. In this process, the lateral wall of the cavernous sinus has been exposed containing the oculomotor and trochlear nerves in its superior portion. The midbrain with the hyper-pigmented substantia nigra is visible at the upper left corner of the image. The oculomotor (CNIII) nerves leave the ventral midbrain, pass through the interpeduncular fossa, and penetrate the dura between the anterior and posterior petroclinoid ligaments lateral to and in front of the posterior clinoid processes. In their course they pass caudal to the posterior cerebral artery, between this and the superior cerebellar artery, both branches of the midline basilar artery. The right trochlear (CNIV) nerve is seen here leaving the dorsal surface of the midbrain and curving around the cerebral peduncle between the posterior cerebral and superior cerebellar arteries to gain the lateral wall of the cavernous sinus. Both nerves enter the orbit via the superior orbital fissure. The trigeminal nerve leaves the lateral surface of the pons and crosses the apex of the petrous bone where it then expands as the trigeminal ganglion. The ganglion lies in Meckel's cave on the trigeminal depression anteromedial to the trigeminal prominence, an elevation on the petrous ridge.  From this sensory ganglion arise its three divisions: ophthalmic (CNV1), maxillary (CNV2), and mandibular (CNV3) coursing toward their openings of exit; superior orbital fissure, foramen rotundum, and foramen ovale, respectively. Deep to the ophthalmic nerve is the abducens nerve. After leaving the pontomedullary sulcus, it ascends on the clivus, penetrates its dura, and passes across the petrous apex below the petrosphenoid ligament (Gruber's ligament; Dorello's canal) to enter the cavernous sinus. Here it courses on the lateral surface of the internal carotid artery before entering the orbit through the superior orbital fissure. Posterolateral to the foramen ovale is the foramen spinosum. The middle meningeal artery can be seen emerging from it. Posterolateral to the trigeminal prominence, the roof of the internal auditory canal has been drilled. In this view, the geniculate ganglion is exposed at the distal end of the canal. Here, the facial nerve continues posteriorly in the facial canal along the medial wall of the tympanic cavity inferior to the lateral semicircular canal and the greater superficial petrosal nerve takes its origin anteriorly from the ganglion. The greater superficial petrosal nerve leaves the anterior surface of the petrous bone through a hiatus and passes deep to the mandibular nerve toward the foramen lacerum and pterygoid canal to unite with the deep petrosal nerve to form Vidian nerve. The distal end of the auditory canal separates the cochlea, anteriorly, from the bony labyrinth and semicircular canals, posteriorly. The thin roof of the tympanic cavity (tegmen tympani) has been drilled away to reveal the middle ear cavity (malleus and incus are exposed). The anterior wall of the tympanic cavity has been opened to reveal two canals, one above the other. The superior of the two contains the tensor tympani muscle and the lower one is the bony part of the Eustachian tube. The tensor tendon curves sharply laterally to attach to the upper part of the handle of the malleus. The superior petrosal sinus is exposed in the tentorial attachment to the petrous ridge. It drains the posterior part of the cavernous sinus to the transverse sinus. (Image courtesy of PA Rubino)

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