Orientation of the Foramen Ovale: An Anatomic Study With Neurosurgical Considerations

Unsuccessful cannulation of the foramen ovale (FO) continues to occur with both fluoroscopic technique and technique using computed tomography paired with navigational technology. Despite advances in stereotactic neurosurgical imaging and technique, anatomic variation of the FO occasionally prevents successful cannulation. Morphometric study of the FO has been limited to length, width, and area parameters; therefore, this report analyzed the orientation of the FO. A total of 139 crania (235 foramina ovalae) were photographed and assessed digitally by ImageJ software (NIH). Foramina were fit with a best fit ellipse. For orientation, the midsagittal plane was located by bisecting the basilar process of the occiput; the coronal plane was identified as perpendicular to the midsagittal plane. The angles between the major axis of the best fit ellipse of the FO and the midsagittal and coronal planes were measured. The angle formed between the major axis of the best fit ellipse of the FO and the coronal plane averaged 35.43° ± 9.74° (mean ± SD) on the left and 36.47° ± 7.60° on the right. The angle formed between the major axis of the best fit ellipse of the FO and the sagittal plane averaged 54.57° ± 9.74° on the left and 53.53° ± 7.60° on the right. No significant difference was found between FO orientation among the sexes. Understanding the orientation of the FO may aid in stereotactic neurosurgical planning and successful cannulation of the FO.