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Endoscopic anatomy of the palatovaginal canal (palatosphenoidal canal)

A Landmark for Dissection of the Vidian Nerve During Endonasal Transpterygoid Approaches

Authors

  • Carlos D. Pinheiro-Neto MD,

    1. the Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A.
    2. Department of Otolaryngology, University of Sao Paulo, Sao Paulo, Brazil
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  • Juan C. Fernandez-Miranda MD,

    Corresponding author
    1. Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A.
    • Department of Neurosurgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite 500, Pittsburgh, PA 15213
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  • Carlos M. Rivera-Serrano MD,

    1. the Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A.
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  • Alessandro Paluzzi MD,

    1. Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A.
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  • Carl H. Snyderman MD, MBA,

    1. Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A.
    2. the Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A.
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  • Paul A. Gardner MD,

    1. Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A.
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  • Luiz U. Sennes MD

    1. Department of Otolaryngology, University of Sao Paulo, Sao Paulo, Brazil
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  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

Demonstrate the endoscopic anatomy of the palatovaginal (PV) canal and artery for identification and dissection of the vidian nerve during endoscopic transpterygoid approaches. Evaluate the length of the PV canal and its relation with the vidian nerve. Show that the traditionally known PV canal is a misnomer and should be renamed.

Study Design:

Experimental study: anatomical and radiological.

Methods:

Dissection of eight cadaveric heads was performed to demonstrate the endoscopic anatomy of the PV canal. Computed tomography scan analysis of 20 patients was used to evaluate the length of the PV canal, the angle formed between this canal and the vidian nerve, and the distance between the vidian canal and the PV canal. Study of 10 dry skull bases was performed to verify the structures involved in the formation of the PV canal.

Results:

Anatomic steps and foundations for dissection of the vidian nerve using the PV canal as a landmark were described. The mean length of the PV canal was 7.15 mm. The mean proximal distance between the vidian and the PV canal was 1.95 mm, and the mean distal distance was 4.14 mm. The mean angle between those canals was 48 degrees. The osteology study showed the vaginal process of the sphenoid bone did not contribute to the formation of the PV canal.

Conclusions:

Our anatomic investigations, radiologic studies, and surgical experience demonstrate the important anatomic relationship of the PV canal with the vidian canal and the relevance of the PV canal as a surgical landmark in endoscopic endonasal transpterygoid approaches. Anatomically, PV canal is a misnomer and should be replaced with palatosphenoidal canal.

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