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Microsurgical anatomy of the trochlear nerve
Author(s) -
Joo Wonil,
Rhoton Albert L.
Publication year - 2015
Publication title -
clinical anatomy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.667
H-Index - 71
eISSN - 1098-2353
pISSN - 0897-3806
DOI - 10.1002/ca.22602
Subject(s) - anatomy , trochlear nerve , neurovascular bundle , medicine , tentorium , orbit (dynamics) , superior orbital fissure , brainstem , cavernous sinus , tentorium cerebelli , cranial nerves , oculomotor nerve , dorsum , alternative medicine , pathology , psychiatry , engineering , palsy , aerospace engineering
The trochlear nerve is the cranial nerve with the longest intracranial course, but also the thinnest. It is the only nerve that arises from the dorsal surface of the brainstem and decussates in the superior medullary velum. After leaving the dorsal surface of the brainstem, it courses anterolaterally around the lateral surface of the brainstem and then passes anteriorly just beneath the free edge of the tentorium. It passes forward to enter the cavernous sinus, traverses the superior orbital fissure and terminates in the superior oblique muscle in the orbit. Because of its small diameter and its long course, the trochlear nerve can easily be injured during surgical procedures. Therefore, precise knowledge of its surgical anatomy and its neurovascular relationships is essential for approaching and removing complex lesions of the orbit and the middle and posterior fossae safely. This review describes the microsurgical anatomy of the trochlear nerve and is illustrated with pictures involving the nerve and its surrounding connective and neurovascular structures. Clin. Anat. 28:857–864, 2015. © 2015 Wiley Periodicals, Inc.