Endoscopic nasopharyngectomy is a feasible and effective surgical treatment for recurrent and residual nasopharyngeal carcinomas.

OBJECTIVEThe foramen lacerum is a relevant skull base structure that has been neglected for many years. From the endoscopic endonasal perspective, the foramen lacerum is a key structure due to its location at the crossroad between the sagittal and coronal planes. The objective of this study was to provide a detailed investigation of the surgical anatomy of the foramen lacerum and its adjacent structures based on anatomical dissections and imaging studies, propose several relevant key surgical landmarks, and demonstrate the surgical technique for its full exposure with several illustrative cases.METHODSTen colored silicone-injected anatomical specimens were dissected using a transpterygoid approach to the foramen lacerum region in a stepwise manner. Five similar specimens were used for a comparative transcranial approach. The osseous anatomy was examined in 32 high-resolution multislice CT studies and 1 disarticulated skull. Representative cases were selected to illustrate the application of the findings.RESULTSThe pterygosphenoidal fissure is the synchondrosis between the lacerum process of the pterygoid bone and the floor of the sphenoid bone. It constantly converges with the posterior end of the vidian canal at a 45° angle, and its posterolateral end points directly to the lacerum foramen. The pterygoid tubercle separates the vidian canal from the pterygosphenoidal fissure, and forms the anterior wall of the lower part of the foramen lacerum. The lingual process, which forms the lateral wall of the foramen lacerum, was identified in 53 of 64 sides and featured an average height of 5 mm. The mandibular strut separates the foramen lacerum from the foramen ovale and had an average width of 5 mm.CONCLUSIONSThis study provides relevant surgical landmarks and a systematic approach to the foramen lacerum by defining anterior, medial, lateral, and inferior walls that may facilitate its safe exposure for effective removal of lesions while minimizing the risk of injury to the internal carotid artery.

During development, neural stem cells (NSCs) undergo transitions from neuroepithelial cells to radial glial cells (RGCs), and later, a subpopulation of slowly dividing RGCs gives rise to the quiescent adult NSCs that populate the ventricular-subventricular zone (V-SVZ). Here we show that VCAM1, a transmembrane protein previously found in quiescent adult NSCs, is expressed by a subpopulation of embryonic RGCs, in a temporal and region-specific manner. Loss of VCAM1 reduced the number of active embryonic RGCs by stimulating their premature neuronal differentiation while preventing quiescence in the slowly dividing RGCs. This in turn diminished the embryonic origin of postnatal NSCs, resulting in loss of adult NSCs and defective V-SVZ regeneration. VCAM1 affects the NSC fate by signaling through its intracellular domain to regulate β-catenin signaling in a context-dependent manner. Our findings provide new insight on how stem cells in the embryo are preserved to meet the need for growth and regeneration.