The Abducens Nerve: Microanatomic and Endoscopic Study

Abstract

Abstract Objective: Only a few anatomic studies concerning the intra- or extracranial course of the abducens nerve (Cranial Nerve VI) have been reported. This is likely because the nerve passes through anatomically intricate areas, making its neurovascular relationships complex. Here we provide an anatomically and surgically oriented classification of the abducens nerve, analyze the microanatomy of the nerve and the surrounding connective and/or neurovascular structures, and provide measurements and anatomic topography. Patients and Methods: A microsurgical anatomic dissection of 55 cadaveric human heads was performed using different skull base approaches to explore the entire course of the VIth cranial nerve, from its origin at the pontomedullary sulcus to the lateral rectus muscle. We then approached the same areas via an endoscopic endonasal transsphenoidal route, analyzed the neurovascular relationships from an anteromedial perspective, and made comparisons with the microsurgical views. Results: The abducens nerve is divided into five segments, of which three are intracranial (cisternal, gulfar, and cavernous) and two are orbital (fissural and intraconal). Using two opposing surgical routes (microsurgical transcranial and endoscopic endonasal approaches) allows us to clearly reveal the spatial relationships of the abducens nerve with other neurovascular structures on the different nerve segments. Conclusion: The classification of five segments for the abducens nerve seems anatomically valid and is surgically oriented with respect to both the microscopic and endonasal endoscopic approaches. It would be useful to explain, segment by segment, the pathogenic mechanism(s) for nerve injuries that are evidenced by lesions that exist along the entire intra- and extracranial course.