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Endoscopic Endonasal View of Gruber’s Ligament

Surgical Correlation

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Endoscopic endonasal approach to the middle clivus. The periosteal dural layer of the clivus has been removed to expose the meningeal or inner layer. The basilar venous plexus has also been removed. During surgery, bleeding from the basilar plexus can be effectively controlled with hemostatic agents. The interdural segment of the abducens nerve runs in between both dural layers, and can now be identified behind the paraclival ICA as it bends over the petrosal process of the sphenoid bone to enter Dorello’s canal. The petrosphenoidal or Gruber’s ligament runs behind the abducens nerve at Dorello’s. (Image courtesy of JC Fernandez-Miranda)

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