J Neurol Surg B Skull Base 2022; 83(S 02): e574-e579
DOI: 10.1055/s-0041-1735589
Original Article

Vidian Canal as a Transcranial Landmark: Anatomy, Technique, and Illustrative Cases

Xiaochun Zhao
1   Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United Sates
,
Daniel M. McKenzie
1   Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United Sates
,
Panayiotis E. Pelargos
1   Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United Sates
,
Ali H. Palejwala
1   Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United Sates
,
Ian F. Dunn
1   Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United Sates
› Author Affiliations
Funding None.

Abstract

Objective The vidian nerve can be accessed in transcranial approaches in carefully selected patients to ensure its preservation and to serve as a landmark for sphenoid sinus entry. This report is to review a technique, evaluate it in laboratory settings, and present two illustrative cases.

Design The study involves cadaveric dissection and illustrative cases.

Setting The study conducted in a cadaveric dissection laboratory.

Participants The object of the study is one cadaveric head and two illustrative clinical cases.

Main Outcome Measures Two cases using this approach were illustrated, and a cadaver dissection was performed in a step-by-step fashion.

Results: The vidian canal can be accessed by drilling the anterolateral triangle. Two illustrated cases were presented; in one, the vidian nerve was used as part of a corridor to access the sphenoid sinus for tumor delivery, and in the other, the technique was used to find and preserve the vidian nerve during transcranial resection.

Conclusion Careful identification of the vidian canal in transcranial surgery is a beneficial technique in carefully selected cases which allows identification of the nerve both for its preservation in selected cases and to create the vidian–maxillary corridor for tumor resection. Knowing the anatomy and pneumatization variants is important in the surgical approach.



Publication History

Received: 09 March 2021

Accepted: 05 August 2021

Article published online:
28 September 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Kassam AB, Vescan AD, Carrau RL. et al. Expanded endonasal approach: vidian canal as a landmark to the petrous internal carotid artery. J Neurosurg 2008; 108 (01) 177-183
  • 2 Wang J, Bidari S, Inoue K, Yang H, Rhoton Jr A. Extensions of the sphenoid sinus: a new classification. Neurosurgery 2010; 66 (04) 797-816
  • 3 Osawa S, Rhoton Jr. AL, Seker A, Shimizu S, Fujii K, Kassam AB. Microsurgical and endoscopic anatomy of the vidian canal. Neurosurgery 2009; 64 (5, suppl 2) discussion 411–412 385-411
  • 4 Hitotsumatsu T, Matsushima T, Rhoton Jr AL. Surgical anatomy of the midface and the midline skull base. Operative Techniques in Neurosurgery 1999; 2 (04) 160-180
  • 5 Tubbs RS, Menendez J, Loukas M. et al. The petrosal nerves: anatomy, pathology, and surgical considerations. Clin Anat 2009; 22 (05) 537-544
  • 6 Nturibi E, Bordoni B. Anatomy, Head and Neck, Greater Petrosal Nerve. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2021
  • 7 Khonsary SA, Ma Q, Villablanca P, Emerson J, Malkasian D. Clinical functional anatomy of the pterygopalatine ganglion, cephalgia and related dysautonomias: a review. Surg Neurol Int 2013; 4 (Suppl. 06) S422-S428
  • 8 Prasad S, Lee TC, Chiocca EA, Klein JP. Superficial greater petrosal neuropathy. Neurol Clin Pract 2014; 4 (06) 505-507
  • 9 Goosmann MM, Dalvin M. Anatomy, head and neck, deep petrosal nerve. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2021
  • 10 Tubbs RS, Custis JW, Salter EG, Sheetz J, Zehren SJ, Oakes WJ. Landmarks for the greater petrosal nerve. Clin Anat 2005; 18 (03) 210-214
  • 11 Hiremath SB, Gautam AA, Sheeja K, Benjamin G. Assessment of variations in sphenoid sinus pneumatization in Indian population: A multidetector computed tomography study. Indian J Radiol Imaging 2018; 28 (03) 273-279
  • 12 Lupascu M, Comsa GI, Zainea V. Anatomical variations of the sphenoid sinus-a study of 200 cases. ARS Medica Tomitana 2014; 20 (02) 57-62
  • 13 Hamid O, El Fiky L, Hassan O, Kotb A, El Fiky S. Anatomic variations of the sphenoid sinus and their impact on trans-sphenoid pituitary surgery. Skull Base 2008; 18 (01) 9-15
  • 14 Sevinc O. et al. Anatomic variations of sphenoid sinus pneumatization in a sample of Turkish population: MRI study. Int J Morphol 2014; 32 (04) 1140-1143
  • 15 Vaezi A, Cardenas E, Pinheiro-Neto C. et al. Classification of sphenoid sinus pneumatization: relevance for endoscopic skull base surgery. Laryngoscope 2015; 125 (03) 577-581
  • 16 Hofstetter CP, Singh A, Anand VK, Kacker A, Schwartz TH. The endoscopic, endonasal, transmaxillary transpterygoid approach to the pterygopalatine fossa, infratemporal fossa, petrous apex, and the Meckel cave. J Neurosurg 2010; 113 (05) 967-974
  • 17 Kirtane MV, Prabhu VS, Karnik PP. Transnasal preganglionic vidian nerve section. J Laryngol Otol 1984; 98 (05) 481-487
  • 18 Shrivastava RK, Sen C, Costantino PD, Della Rocca R. Sphenoorbital meningiomas: surgical limitations and lessons learned in their long-term management. J Neurosurg 2005; 103 (03) 491-497
  • 19 Attia M, Patel KS, Kandasamy J. et al. Combined cranionasal surgery for spheno-orbital meningiomas invading the paranasal sinuses, pterygopalatine, and infratemporal fossa. World Neurosurg 2013; 80 (06) e367-e373