Clinical implications in orbital and pterional flap surgeries as well as radioimaging studies to determine topographical prevalence and characterization of meningo-orbital foramen in orbits of the Indian population / Implicaciones clínicas en cirugías de colgajo orbitario y pterional, así como estudios de radioimagen para determinar la prevalencia topográfica y la caracterización del foramen meningoorbitario en órbitas de la población india

SUMMARY: The pear-shaped bony orbit connects with intracranial cavity via foramina's and fissures. The Meningo-orbital Foramen (MOF) is usually present in greater wing of sphenoid close to lateral edge of Superior orbital fissure. It provides a route for an anastomosis between the orbital branch of the middle meningeal artery (MMA) and recurrent meningeal branch of Ophthalmic Artery (OA) and hence, risk of damage during surgeries can occur. To verify occurrence and location, with morphology of MOF in dry orbits and the impending clinical hazards in surgeries pertaining to the orbit, document and analysis it to determine a standardized guideline. The presence for MOF was studied in 446 dry orbits with its location from the supra orbital margin (SOM), front zygomatic suture (FZS), the lateral tubercle of Whitnall (WT)and the lateral end of superior orbital fissure (SOF) along with its patency, laterality and number of foramina's present. Nylon probes, long divider/pins, compass and Vernier callipers was used to check the patency and various parameters. The study noted the percentage prevalence of MOF as 69 % with communication with middle cranial fossa (MCF) being 76 % of 69 % and the average distance from SOM, FZS, WT and lateral end of SOF being 35.58 mm, 24.9 mm, 26.6 mm and 0.92 mm. On comparison with various population studies, certain similarities and differences with regards to different parameters were noted. Prevalence of MOF was mostly unilateral and showed multiple foramina, that can act as channels for arteries, a variant of MMA or OA, that supply orbital structures or tumour growths. Thus, awareness of this variation is of prime importance to ophthalmologists and neurosurgeons as well as interventional radiologists, in preventing haemorrhagic condition which could further raise the difficulties in operative procedures and surgical outcomes.

RESUMEN: La órbita ósea en forma de pera se conecta con la cavidad intracraneal a través de forámenes y fisuras. El foramen meningoorbitario (MOF) suele estar presente en el ala mayor del esfenoides cerca del margen lateral de la fisura orbitaria superior. Proporciona una ruta para una anastomosis entre la rama orbitaria de la arteria meníngea media (MMA) y la rama meníngea recurrente de la arteria oftálmica (OA) y, por lo tanto, puede ocurrir riesgo de daño durante las cirugías. Para verificar la ocurrencia y ubicación, con la morfología de MOF en órbitas secas y los peligros clínicos inminentes en cirugías de la órbita, documentarlo y analizarlo para determinar una pauta estandarizada. Se estudió la presencia de MOF en 446 órbitas secas desde el margen supraorbitario (MOS), sutura cigomática frontal (FZS), el tubér- culo lateral de Whitnall (WT) y el extremo lateral de la fisura orbitaria superior (SOF) junto con su permeabilidad, lateralidad y número de forámenes presentes. Se utilizaron sondas de nailon, divisores / pasadores largos, brújula y calibradores Vernier para comprobar la permeabilidad. En el estudio se pudo observar que la prevalencia porcentual de MOF era del 69 %, siendo la comunica- ción con la fosa craneal media (MCF) del 76 % del 69 % y la distancia promedio desde SOM, FZS, WT y el extremo lateral de SOF era de 35,58 mm, 24,9 mm, 26,6 mm y 0,92 mm. En comparación con varios estudios de población, se observaron ciertas similitudes y diferencias con respecto a diferentes parámetros. La prevalencia de MOF fue mayoritariamente unilateral y mostró múltiples forámenes, que pueden actuar como canales para las arterias, una variante de MMA u OA, que irrigan estructuras orbitarias o crecimientos tumorales. Por lo tanto, la conciencia de esta variación es de primordial importancia para los oftalmólogos y neurocirujanos, así como para los radiólogos intervencionistas, en la prevención de una enfermedad hemorrágica que podría aumentar aún más las dificultades en los procedimientos y los resultados quirúrgicos.

Foramen meningo orbitario / Meningo orbital foramen

El foramen meningo orbitario (FMO), ubicado en el ala mayor del esfenoides y cercano al extremo lateral de la fisura orbitaria superior (FOS), comunica órbita con fosa craneal media, permitiendo el paso de una anastomosis entre las arterias oftálmica y meníngea media. Su prevalencia varía del 6 al 82,9 % y puede presentarse en forma unilateral o bilateral, único o múltiple y de forma circular, ovoidal o de ranura. Nuestro objetivo fue evidenciar la presencia del FMO, describiendo sus características morfológicas, en cráneos secos de individuos adultos chilenos de ambos sexos. Se utilizaron 54 cráneos con ambas órbitas. Se consideró; presencia, unilateralidad o bilateralidad, cantidad de forámenes por órbita, forma, ubicación en relación al plano horizontal determinado por el extremo lateral de la FOS, distancia al extremo lateral de la FOS, diámetro y diferencias sexuales. Las mediciones se realizaron con sonda de nylon, compás de puntas secas y cáliper digital. Un 46,29 % de la muestra presentó FMO, con mayor presencia en individuos femeninos. En un 28 % se presentó unilateral y en un 72 % bilateral. Predominó la forma circular (79,07 %) sobre la ovoidal (18 %) y sobre la forma de ranura (2,33 %). El FMO se observó en un 90,69 % sobre el plano horizontal que determina el extremo lateral de la FOS y en un 9,31 % en el mismo plano. La distancia del FMO al extremo lateral de la FOS fue de 6,58 mm y el diámetro del FMO correspondió a 1,22 mm. Nuestros resultados coinciden con la literatura, respecto a su presencia, a la comunicación que permite, a su ubicación, a su forma y tamaño. Se pudo constatar semejanzas y algunas diferencias menores con cráneos indios, asiáticos y pakistaníes. También pudimos evidenciar diferencias por sexo. El conocimiento acabado del FMO tiene importancia en anatomía, antropología, oftalmología, traumatología, imagenología, cirugía e identificación humana.

The meningo orbital foramen (MOF) is located in the major wing of the sphenoid and near the lateral end of the superior orbital fissure (SOF), communicating orbit with the middle cranial fossa and allowing the passage of an anastomosis between the ophthalmic and middle meningeal arteries. Its prevalence varies from 6 to 82.9 % and may occur unilaterally or bilaterally, single or multiple, and may have a circular, ovoid or groove form. The aim of this study is to evidence the existence of MOF, describing its morphological characteristics in dry skulls of Chilean adults of both sexes. The present study analyzed 54 skulls containing both orbits, considering the following criteria: Existence, unilaterality or bilaterality, number of foramens by orbit, shape, location in relation to the horizontalbaselinedetermined by the lateral end of the SOF, distance to the lateral end of the SOF and diameter and variations by sex. Measurements were made with nylonprobe,compass dry point and digital caliper. Of the sample, 46.29 % presented MOF with a greater prevalence in female samples. In 28 % of the cases it was unilateral and in the other 72 % bilateral. The circular shape was predominant in 79.07 %, followed by the ovoidal 18 % and thegrooveform 2.33 %. The MOF was observed in 90.69 % on the horizontalbaselinethat determines the lateral end of the SOF and in 9.31 % in the samebaseline. The average distance from the MOF to the lateral end of the SOF was 6.58 mm and the diameter of the MOF corresponded to 1.22 mm. Our results are consistentwith similar studies. There were some minor differences observed in Indian, Asian andPakistani skulls as well as some anatomical differences by sex. A better understanding of MOF plays an important role in anatomy, anthropology, ophthalmology, traumatology, medical imaging, surgery and human identification.

Isolated Left Trochlear Nerve Palsy Caused by Sphenoid Sinus Mucocele / 대한이비인후과학회지

Paranasal sinus mucoceles are an uncommon cause of isolated palsies of cranial nerves III, IV, and VI. The trochlear nerve has been reported to be less frequently affected than the abducens and oculomotor nerves. Isolated sphenoid sinus diseases may cause serious complications by involving adjacent vital structures such as the optic nerve, cavernous sinus, internal carotid artery, and cranial nerves III–VI. We report a case of a 76-year-old woman who presented to our emergency department with a chief complaint of acute double vision and headache. Her diplopia was diagnosed as left trochlear nerve palsy. Brain CT and MRI revealed expanding cystic lesions in both sphenoid sinuses with bony erosion of the left sinus wall. The patient underwent an endoscopic intranasal sphenoidotomy and recovered completely from diplopia at postoperative 2 months. The relationship between the trochlear nerve palsy and its anatomy is also discussed.

Herpes zoster ophthalmicus presenting as orbital abscess along with superior orbital fissure syndrome: A case report.

Orbital abscess and superior orbital fissure syndrome (SOFS) are rare manifestations of herpes zoster ophthalmicus. Herein, we report a case of orbital abscess along with SOFS in a 2.5‑year‑old‑male child secondary to herpes zoster infection. He presented with a 5‑day history of proptosis and ptosis of the right eye that had been preceded by vesicular eruptions on the right forehead and scalp. Computed tomography scan of the head and orbit showed orbital abscess and right cavernous sinus thrombosis. A diagnosis of orbital abscess with SOFS secondary to herpes infection was made. The condition subsequently improved following antiviral therapy, intravenous vancomycin and amikacin, and oral corticosteroids

A Case of Superior Orbital Fissure Syndrome Induced by Penetrating Orbital Injury

PURPOSE: We report a case of superior orbital fissure syndrome induced by penetrating orbital injury caused by a steel wire and analyzed the clinical outcomes. CASE SUMMARY: A 49-year-old female visited our clinic after a penetrating orbital injury through the right inferolateral conjunctiva caused by a steel wire. The best corrected visual acuity of the right eye was 0.8 and a fixed dilated pupil was detected. Partial ptosis and ophthalmoplegia were observed in the right eye. The computed tomography image revealed no sign of orbital wall fracture, retrobulbar hemorrhage or foreign body. Slightly increased signal intensity was observed on the magnetic resonance image but other abnormal findings of the extraocular muscle and optic nerve were not detected. Under the impression of superior orbital fissure syndrome, systemic steroid was administered orally. After 1 month, ptosis and ophthalmoplegia were partially improved. After 3 months, the pupil size and response were normalized. CONCLUSIONS: The oral steroid treatment was given to reduce the edema without orbital wall fracture after the penetrating orbital injury, which caused the superior orbital fissure syndrome. The symptom was relieved 3 months after the injury.

Observation of the effect of skull base meningioma communicate through the superior orbital fissure cranio-orbital approach of microsurgery / 中国基层医药

Objective To investigate the skull base meningiomas communicate through the superior orbital fissure cranio-orbital approach of microsurgical Methods and the efficacy.Methods 80 cases with skull base meningiomas were randomly divided into the control group and observation group,40 cases in each group.The control group was given contact microsurgery,and the observation group received communication through the superior orbital fissure cranio-orbital approach of micro-surgery.The improvement of symptoms and postoperative complications were compared and analyzed.Results (1)The operative time,blood loss,blood transfusion,Simpson grade (Ⅰ,Ⅱ,Ⅲgrade),DKPS,postoperative hospital stay and mortality rate in the control group were (9.28 ± 0.97)h,(1 222.38 ± 89.07) mL,(1 099.35 ±56.72) mL,14/17/9,3.21 (0,6.44),(29.78 ±3.29)d and 7.50％ (3/40),which in the observation group were (7.02 ± 0.65) h,(877.34 ± 44.50) mL,(677.10 ± 32.28) mL,29/9/2,3.26 (-3.33,10),(20.00 ± 2.75) d and 5.00％ (2/40).The differences of operative time,blood loss,blood transfusion,Simpson level,postoperative hospital stay between the two groups were statistically significant(t =4.209,4.997,5.823,x2 =4.011,t =5.711,P =0.033,0.027,0.018,0.022,0.013),but the D KPS and mortality between the two groups had no significant differences (t =0.433,0.096,P =0.089,0.317).The monocular prominent,eye movement disorder and vision improvement rates in the control group were 66.67％,72.22％ and 75.68％,which were significantly lower than 92.31％,94.12％ and 97.14％ in the observation group (x2 =5.932,4.381,6.793,P =0.027,0.033,0.020).The postoperative eye movement disorder,on ptosis,eye abduction,subcutaneous fluid and intracranial infection rates in the control group were 10.00％,15.00％,30.00％,12.50％ and 7.50％,those in the observation group were 7.50％,5.00％,10.00％,10.00％ and 7.50％.The postoperative eye movement disorder,subcutaneous fluid and intracranial infection rates had no significant differences between the two groups(x2 =0.923,1.033,0.785,P =0.387,0.595,0.233).The incidence rates of postoperative ptosis,abduction eyeball had statistically significant differences between the two groups (x2 =6.299,7.889,P =0.018,0.009).Conclusion The skull base meningiomas communicate through the superior orbital fissure cranio-orbital approach of microsurgery has significant effect than the conventional contact microsurgery,which deserves to be promoted in clinical.

The foramen meningo-orbital in Indian dry skulls.

Background & objective: Foramen meningo-orbital is present in greater wing of sphenoid bone close to superior orbital fissure. It provide route for an anastomosis between the orbital branch of the middle meningeal artery and recurrent meningeal branch of ophthalmic artery. Basic textbooks of anatomy stated that it was a rare occurrence but some recent studies indicate a more frequent incidence of this which shows side and gender variation. These discrepancies were verified in our research work. Methods: We studied 150 dried human skulls (100 male and 50 female) of known sex. Only patent foramina were included in the observation. Results: Incidence of foramen as whole was 44.33% (male- 37.5% and female- 58%). In 4%, it was present bilaterally. Average distance between lateral end of superior orbital fissure and foramen was 6.22 mm. Conclusion: Our study indicates that a foramen meningo-orbital is present as often as, mostly unilaterally and multiple foramina may exist and also it shows side and genders variation. Knowledge of it may be of surgical significance to ophthalmologist and neurosurgeons and for radiologist because it masquerading as an intraocular foreign body. Further detail study on this topic in other populations from different areas is required.

Meningeal Layers Around Anterior Clinoid Process as a Delicate Area in Extradural Anterior Clinoidectomy : Anatomical and Clinical Study

OBJECTIVE: Removal of the anterior clinoid process (ACP) is an essential process in the surgery of giant or complex aneurysms located near the proximal internal carotid artery or the distal basilar artery. An extradural clinoidectomy must be performed within the limits of the meningeal layers surrounding the ACP to prevent morbid complications. To identify the safest method of extradural exposure of the ACP, anatomical studies were done on cadaver heads. METHODS: Anatomical dissections for extradural exposure of the ACP were performed on both sides of seven cadavers. Before dividing the frontotemporal dural fold (FTDF), we measured its length from the superomedial apex attached to the periorbita to the posterolateral apex which connects to the anterosuperior end of the cavernous sinus. RESULTS: The average length of the FTDF on cadaver dissections was 7 mm on the right side and 7.14 mm on the left side. Cranial nerves were usually exposed when cutting FTDF more than 7 mm of the FTDF. CONCLUSION: The most delicate area in an extradural anterior clinoidectomy is the junction of the FTDF and the anterior triangular apex of the cavernous sinus. The FTDF must be cut from the anterior side of the triangle at the periorbital side rather than from the dural side. The length of the FTDF incision must not exceed 7 mm to avoid cranial nerve injury.

Superior Orbital Fissure Syndrome after Repair of Blow Out Fracture

PURPOSE: Superior orbital fissure syndrome is a rare neurological complex. Superior orbital fissure syndrome may result from a variety of inflammatory, infectious, neoplastic, iatrogenic, traumatic, vascular cause. The author report a patient who suffered from superior orbital fissure syndrome after inferior orbital wall reduction. METHODS: A 26-year-old female suffered from inferior orbital wall fracture with inferior gaze limitation and orbital soft tissue herniation. On posttrauma 10 day, inferior orbital wall was reduced using endoscope and porous polyethylene(Medpor(R)) was inserted. On immediate postoperation, she reported that extraocular movement was limited in almost any directions. She underwent exploration surgery to release the presence of extraocular muscle impingement. But, there was no observation of extraocular muscle impingement. On postoperative one day, high- dose steroid therapy was started to release superior orbital fissure syndrome which was defined in postoperative computed tomography. RESULTS: After one month of high-dose steroid therapy, extraocular movement limitations improved progressively in all directions. In four months, extraocular movement recovered completely. CONCLUSION: Superior orbital fissure syndrome may occur after surgical procedure of orbital wall reduction. Prompt diagnosis and treatment with mega-dose corticosteroid is an effective option for avoiding disaster from compressive syndrome.

Recent progress in radiological study of cranial nerve injury / 第二军医大学学报

The vast majority of traumatic cranial nerve injuries are associated with compression of fragment fracture, and microsurgery outside the epidural can be used for most of the cases. Therefore, early and accurate diagnosis of cranial nerve injury is especially important. As the cranial nerves go out of the cranial cavity through the holes and cracks of the skull base, and there are a number of special structures through which cranial nerve goes into the human skull, and they include the optic canal, superior orbital fissure, facial nerve canal, jugular foramen and so on. Most traumatic cranial nerve injuries are associated with these structures; however, the common imaging examination is very difficult for these structures due to their deep location. To further study the imaging diagnosis of cranial nerve injury associated with traumatic brain injury, this paper reviews the radiological technology for examination of the special positions in the skull.

An unusual case of total ophthalmoplegia.

An eight-year-old male child presented with drooping of the left eyelid with a history of penetrating injury of hard palate by an iron spoon seven days ago, which had already been removed by the neurosurgeon as the computed tomography scan revealed a spoon in the left posterior ethmoid and sphenoid bone penetrating into the middle cranial fossa. On examination, visual acuity was 20/20 in each eye and left eye showed total ophthalmoplegia. Oral cavity revealed a hole in the left lateral part of the hard palate. We managed the case with tapering dose of systemic prednisolone. The total ophthalmoplegia was markedly improved in one month. Cases of foreign bodies in the orbit with intracranial extension are not unusual, but the path this foreign body traveled through the hard palate without affecting the optic nerve, internal carotid artery or cavernous sinus makes an interesting variation.

Surgical operation for traumatic superior orbital fissure syndrome following traumatic brain injury / 中华创伤杂志

Objective To compare curative effect of decompression and conservative treatment for traumatic superior orbital fissure syndrome to discuss the operation indications and the operative oppor-tunity for this syndrome. Methods Data of 12 patients (seven males and five females) with 14 sides were compared to evaluate different curative effect between decompression and conservative treatment so as to optimize the initial corresponding treatment. Results The patients were at mean age of 28 years and followed up for mean six months. All patients were complicated by one and more of following symptoms in-cluding ophthalmoplegia, ptosis, proptosis and anaesthesia in the distribution of V1 and a fixed dilated pupil. There was one patient complicated by orbital apex syndrome. CT showed involvement of the superi-or orbital fissure in seven patients. Of seven patients treated with decompression, six got recovery at dif-ferent degrees. Meanwhile, three out of five patients treated with conservative treatment recovered to some extent. Conclusions Early effective treatment can improve the functional rehabilitation of the injured nerve. Decompression of superior orbital fissure is proved to be effective in ameliorating symptome, re-ducing disability and improving quality of life.

Traumatic Superior Orbital Fissure Syndrome: Case Report

The superior orbital fissure syndrome is characterized by external ophthalmoplegia, ptosis, exophthalmos, fixed, dilated pupil, and anesthesia of the upper eyelid and forehead. This syndrome is a complex of impaired function of the cranial nerves that enter the orbit through superior orbital fissure. Three major causal factors are tumors, inflammation and trauma. We present a patient who had signs and symptoms of superior orbital fissure syndrome after traumatic zygomaticomaxillary fractures. After surgical reduction of fractured zygomaticomaxillary bone segment and conservative management, complete functional recovery of the eye was noted.

A case of metastatic hepatocellular carcinoma to orbit with superior orbital fissure syndrome / 대한내과학회지

The superior orbital fissure syndrome is a rare condition characterized by opthalmoplegia, ptosis, and proptosis of the eye, fixation and dilation of the pupil, and anesthesia of the upper eyelid and forehead. Tumor metastasis to the orbit is uncommon and there were only 11 histologically proven cases of metastatic hepatocellular carcinoma to the orbit. There was only one case of metastatic hepatocellular carcinoma to the orbit with superior orbital fissure syndrome. The prognosis were poor for all reported cases, but palliative radiotherapy could be some help. We report a rare case of metastatic hepatocellular carcinoma to the orbit with superior orbital fissure syndrome.

A case of Superior Orbital Fissure Syndrome

PURPOSE: The superior orbital fissure syndrome is a complex of impaired function of the cranial nerves that enter the orbit through this fissure. It is a very rare disease which is characterized by ophthalomoplegia, ptosis and proptosis of the eye, reflex dilation of the pupil, and anesthesia of the upper eyelid and forehead. This syndrome may be the result of craniofacial bone fractures as well as neoplasm of the retrobulbar space, hematomas in the orbital muscle cone and retrobulbar space, and hematoma and infection of the cavernous sinus. In this case, 12 year-old boy was stung at his medial side of the right upper eyelid by fishing-rod. This patient is described with features of a superior orbital fissure syndrome. Superior orbital fissure syndrome is a very rare disease. We report a case of superior orbital fissure syndrome. METHODS: Ptosis and complete external ophthalmoplegia were found in that eye. Snellen acuity of the right eye was 20/20. Dilation of the right pupil with loss of sensation on the right upper side of eyelid and forehead was noted. Under the impression of superior orbital fissure syndrome, systemic steroid was administered orally. RESULTS: A month after trauma, the patinet had no limit of motion at extraocular muscle except upward gaze and improved ptosis. Three months after the trauma, the patient had no signs and symptoms except sluggish pupillary reflex on the right eye.

Morphometric Aspect of Juxta-Clinoidal Cranial Nerves / 대한뇌혈관학회지

OBJECTIVE: During anterior clinoidectomy for aneurysms of ophthalmic artery or paraclinoidal lesions, not only optic nerve but also cranial nerves passing through the superior orbital fissure (SOF) can be damaged by mechanical or thermal injury. Particularly, revision for paraclinoidal lesions can give further damage to the cranial nerves because of the obscure anatomical structure resulting from the tight fibrous adhesion. Thus, to reduce the damage of the cranial nerves passing through the SOF during the anterior clinoidectomy or optic canal decompression via the extradural or intradural route, morphometric relationship of juxta-clinoidal cranial nerves were studied. MATERIALS AND METHODS: Using 15 adult formalin fixed cadavers, the anatomical landmarks for measurements were chosen as follows: lateral entry point of optic nerve into the optic canal (LON), tip of anterior clinoid process (ACP), tip of posterior clinoid process (PCP), upper border of lesser wing of sphenoid bone, and lateral end of SOF. The measurements were carried out as follows: 1) distance from the LON to the dural entry point (DEP) of the third (III), fourth (IV), and ophthalmic branch of the fifth (V1) nerves into the tentorium, 2) distance from the tip of PCP to the DEP of III and VI cranial nerves, 3) distance from the LON to the cranial nerves within intradural space before passing through SOF, 4) The shortest depth from the tip of ACP and the edge of lesser wing to the cranial nerves passing through the cavernous sinus, 5) distance from the lateral end of SOF to the cranial nerves just before passing through the annular tendon. RESULTS: The mean distance from the LON to the DEP of the III, IV, and V1 cranial nerves were 10.4 mm, 18.8 mm, and 23.4 mm, respectively. The mean distance from the tip of PCP to the DEP of the III and VI cranial nerves were 5.4 mm and 18.6 mm, respectively. DEP of the III cranial nerve was corresponded with the just anterior coronal plane of PCP. The mean distance from the LON to the III, IV, and V1 cranial nerves passing through the SOF were 7.2 mm, 10.0 mm, 10.5 mm and 10.6 mm, respectively. The III cranial nerve located at a mean depth of 3.4 mm from the tip of ACP. The IV, V1 , and VI cranial nerves located at a mean depth of 2.1 mm, 2.4 mm and 7.4 mm from the upper border of lesser wing of sphenoid bone, respectively. The III cranial nerve splitted into superior and inferior divisions at a mean distance of 1.51 mm from the lateral end of SOF, just before where it passes through the SOF. The mean distance from the lateral end of SOF to the lateral margins of the III, IV and frontal nerves of V1 were 12.5 mm, 11.0 mm and 10.2 mm, respectively. CONCLUSION: DEP of the III cranial nerve was corresponded with the just anterior coronal plane of PCP and was about a half distance from PCP than from LOP. DEP of the IV cranial nerve looks like same site as that of V1 cranial nerve, but IV cranial nerve located at just superior to V1. From the LON, III, IV, V1 , and VI CNs latero-inferiorly passed through the SOF. The III cranial nerve located at the most medial portion of SOF with a mean distance of 7 mm, and the IV, V1 and VI cranial nerves were arranged in the same order as vertical arrangement with a mean distance of 10 mm. The cranial nerves just before passing through SOF were located at a range of 7.8 to 20 mm from the lateral end of SOF. This study facilitates an understanding of the anatomy of juxta-sellar region and may help to reduce the cranial nerve injury at the surgery around juxta-clinoidal CNs.

Traumatic Superior orbital fissure syndrome complicating fractures of the facial skeleton: Report of a Case