CLIVAL ANATOMY AND DIVISION скачать в хорошем качестве

CLIVAL ANATOMY AND DIVISION

UPPER CLIVUS three parts-upper, middle and lower -. Above the abducens nerve ,the upper clivus part is located.Sphenoid sinus, sella turcica, midbrain, basilar artery, cranial nerves III, IV, V, VI, cavernous sinus and temporal lobes are the upper part’s boundaries which include the posterior clinoid processes and dorsum sellae. MID CLIVUS Between the 6th and ninth cranial nerves exits, the middle clivus part is located. Cranial nerves VII and VIII, basilar artery, pons, upper nasopharynx,Petrous apices and retropharyngeal tissues are the boundaries of this part. LOWER CLIVUS From the ninth cranial nerve to the foramen magnum, the lower clivus part is located. Cranial nerves IX, X,XI, XII, sigmoid sinus, medulla, vertebral artery, retropharyngeal tissues, jugular bulb and lower nasopharynx are the boundaries of this part. There are three general approaches to reach clivus which are anterior, anterolateral and posterolateral ones. Extradural lesions with primary clivus involvement and extracranially extension need anterior approaches like transcervical,transethmoidal,trans-sphenoidal, transmaxillary, transoral-transpalatal and subfrontal transbasal extra intradural approaches. Chondromas, pituitary tumors, chondrosarcomas, and craniopharyngiomas are the lesions which can be reached by these approaches. The subtemporal transtentorial and frontotemporal trans-sylvian approaches are the anterolateral approaches which are mainly used for the upper and middle intradural clivus tumors with surrounding regions extension.