Duplication of the Abducens Nerve at the Petroclival Region: An Anatomic Study

Özveren, Mehmet Faik; Şam, Bülent; Akdemir, Ismail; Alkan, Alpay; Tekdemi̇r, İbrahi̇m; Deda, Haluk

doi:10.1227/01.neu.0000048186.18741.3c

Cited by 57 publications

(59 citation statements)

References 22 publications

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“…Type I was the most common and followed the classic anatomical descriptions. Type II and III accounted for less than 10% of the cases respectively 6,8,9) . These aberrations of the abducens nerve can be explained by the fact that the oculomotor, trochlear, abducens, and hypoglossal nerves constitute the somatic efferent group developed from the ventral lamina of the midbrain during embryological development and the abducens nerve is in the form of two aberrant branches and so, variations can occur if these branches are not absorbed 5,18) .…”

Section: Discussionmentioning

confidence: 95%

“…However, the aberrations of the abducens nerve have been reported to range between 8 and 18% [4][5][6]8,9) and also the relevant literatures have shown the incidence of the bilateral duplication to range between 0 and 8% 6,8,9) . According to 2.…”

Section: Discussionmentioning

confidence: 99%

“…So, the authors think that it is required to take the possibility of the aberration of the abducens nerve into consideration while one performs the neurosurgical procedures in the petroclival region to avoid inadvertent injury. Ozveren et al 9) defined six types of aberrant abducens nerve on the base of work of Nathan et al 8) . According to their classifications, Type I represents the most common whereby the nerve emerges from the brain stem as a single trunk and enters the cavernous sinus and then the orbit as such.…”

Section: Discussionmentioning

confidence: 99%

“…So, someone insist that the term of petroclival venous confluens is appropriate instead of Dorello's canal 1) . The abducens nerve is enveloped by cerebral dura of petroclival region, separated from the venous blood and the subarachnoid space also extends toward the cavernous sinus along the nerve 1,2,[9][10][11][12]14,17) . We also found the both branches to be enveloped by cerebral dural layer and separated from venous blood.…”

Section: Discussionmentioning

confidence: 99%

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A Case of Aberrant Abducens Nerve in a Cadaver and Review of Its Clinical Significance

Choi

Han

Yee

et al. 2010

J Korean Neurosurg Soc

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J Korean Neurosurg Soc 47 : [377][378][379][380] 2010 The abducens nerve usually travels from the brainstem to the lateral rectus muscle as a single trunk. However, it has been reported that this nerve could split into branches occasionally. We attempted to show the aberrant course of abducens nerve in a specimen with unilateral duplicated abducens nerve and review relevant literatures. The micro-dissections were performed in a head specimen injected with colored latex under the microscope. The abducens nerve was duplicated unilaterally. This nerve emerged from the pontomedullary sulcus as a single trunk and splitted into two branches in the prepontine cistern. These two separate branches were piercing the cerebral dura of the petroclival region respectively. The slender lower branch passed between the petroclinoid and petrosphenoid ligaments and the thick lower one passed under the petrosphenoid ligament. These two branches united just lateral to the ascending segment of internal carotid artery in the cavernous sinus. The fact that there are several types of aberrant abducens nerve is helpful to perform numerous neurosurgical procedures in the petroclival region and cavernous sinus without inadvertent neurovascular injuries.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A Case of Aberrant Abducens Nerve in a Cadaver and Review of Its Clinical Significance

Choi

Han

Yee

et al. 2010

J Korean Neurosurg Soc

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“…Autopsies may show abducens nerve division into two or more trunks, 18,19 some widely separated at the cavernous sinus. 18 The medial rectus (MR) motor nerve also bifurcates and arborizes into nonoverlapping superior and inferior compartments of roughly equal size.…”

Section: Anatomic Evidence For Eom Compartmentalizationmentioning

confidence: 99%

Compartmentalization of extraocular muscle function

Demer

2014

Eye

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Ocular motor diversity exceeds capabilities of only six extraocular muscles (EOMs), but this deficiency is overcome by the plethora of fibers within individual EOMs surpassing requirements of homogeneous actuators. This paper reviews emerging evidence that regions of individual EOMs can be differentially innervated to exert independent oculorotary torques, broadening the oculomotor repertoire, and potentially explaining diverse strabismus pathophysiology. Parallel structure characterizes EOM and tendon fibers, with little transverse coupling of experimentally imposed or actively generated tension. This arrangement enables arbitrary groupings of tendon and muscle fibers to act relatively independently. Coordinated force generation among EOM fibers occurs only upon potentially mutable coordination of innervational commands, whose central basis is suggested by preliminary findings of apparent compartmental segregation of abducens motor neuron pools. Humans, monkeys, and other mammals demonstrate separate, nonoverlapping intramuscular nerve arborizations in the superior vs inferior compartments of the medial rectus (MR) and lateral rectus (LR) EOMs that could apply force at the superior vs inferior portions of scleral insertions, and in the medial vs lateral compartments of the superior oblique that act at the equatorial vs posterior scleral insertions that might preferentially implement incycloduction vs infraduction. Magnetic resonance imaging of the MR during several physiological ocular motor behaviors indicates differential compartmental function. Differential compartmental pathology can influence clinical strabismus. Partial abducens palsy commonly affects the superior LR compartment more than the inferior, inducing vertical strabismus that might erroneously be attributed to cyclovertical EOM pathology. Surgery may selectively manipulate EOM compartments.

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