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J Neurol Surg B Skull Base 2023; 84(03): 210-216
DOI: 10.1055/a-1780-4619
Original Article

Histology of the Porous Oculomotorius: Relevance to Anterior Skull Base Approaches

Robert C. Rennert
1   Department of Neurological Surgery, University of California San Diego, La Jolla, California, United States
,
Vanessa Goodwill
2   Department of Pathology, University of California San Diego, La Jolla, California, United States
,
Jeffrey A. Steinberg
1   Department of Neurological Surgery, University of California San Diego, La Jolla, California, United States
,
Takanori Fukushima
3   Department of Neurosurgery, Neuroscience Institute, Raleigh, North Carolina, United States
,
John D. Day
4   Department of Neurosurgery, University of Arkansas, Little Rock, Arkansas, United States
,
Alexander A. Khalessi
1   Department of Neurological Surgery, University of California San Diego, La Jolla, California, United States
,
Michael L. Levy
5   Department of Neurosciences and Pediatrics, University of California San Diego, San Diego, California, United States
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Abstract

Objective Mobilization of cranial nerve III (CNIII) at its dural entry site is commonly described to avoid damage from stretching during approaches to the parasellar, infrachiasmatic, posterior clinoid, and cavernous sinus regions. The histologic relationships of CNIII as it traverses the dura, and the associated surgical implications are nonetheless poorly described. We herein assess the histology of the CNIII–dura interface as it relates to surgical mobilization of the nerve.

Methods A fronto-orbitozygomatic temporopolar approach was performed on six adult cadaveric specimens. The CNIII–dural entry site was resected and histologically processed. The nerve–tissue planes were assessed by a neuropathologist.

Results Histologic analysis demonstrated that CNIII remained separate from the dura within the oculomotor cistern (porous oculomotorius up to the oculomotor foramen). Fusion of the epineurium of CNIII and the connective tissue of the dura was seen at the level of the foramen, with no clear histologic plane identified between these structures.

Conclusion CNIII may be directly mobilized within the oculomotor cistern, while dissections of CNIII distal to the oculomotor foramen should maintain a thin layer of connective tissue on the nerve.

Keywords

oculomotor nerve - cavernous sinus - histology - porous oculomotorius


Publication History

Received: 12 January 2022

Accepted: 17 February 2022

Accepted Manuscript online:
23 February 2022

Article published online:
11 April 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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