Variant Bilateral Foramina of the Middle Cranial Fossa

Variations of the foramina located at the skull base can have direct clinical implications. For example, transcutaneous approaches to the trigeminal nerve using long spinal needles for treatment of trigeminal neuralgia can inadvertently enter such variant foramina and potentially result in hemorrhage. Therefore, knowledge of such variant foramina is important to the clinician treating or diagnosing patients based on imaging of this region. We report an adult male skull found to have unusual foramina located at the skull base. The foramina were located approximately 3.1 cm lateral to the plane of the foramen rotundum and foramen ovale. The left foramen had a diameter of 0.82 mm and the right foramen had a diameter of 0.77 mm. Both foramina opened up just medial to the sphenotemporal suture into the roof of the infratemporal fossa. Additionally, each foramen was the most lateral of a larger collection of foramina found to exit the skull base but confluent with the diploic space of the greater wind of the sphenoid and not with the floor of the middle cranial fossa. This group of openings, including the most lateral which communicated with the middle cranial fossa, were lateral to the lateral plate of the pterygoid process. Knowledge of variant foramina of the skull base is important to clinicians treating patients with pathology of this region. To our knowledge, foramina as described herein have not been previously reported in the extant medical literature.