Original Article
Brainatomy: A Novel Way of Teaching Sphenoid Bone Anatomy With a Simplified
3-Dimensional Model
Kadir Er, Kirsten Schmieder, Christopher Brenke, Dorothea Miller, Yaroslav Parpaley, Mortimer Gierthmuehlen
- BACKGROUND: The diagnosis and treatment of dis-
eases at and around the sphenoid bone demands
throughout understanding of its anatomy in 3-dimensional
(3-D) space. However, despite the complex anatomic na-
ture of the sphenoid bone, the current educational re-
sources for its 3-D anatomy are insufficient for fast and
long-term retention of the anatomic relationships.
- OBJECTIVE: To provide a simplified 3-D model of the
sphenoid bone that anyone can easily learn and recall as
an internal mental model.
- METHODS: Various studies on the anatomy of the
sphenoid bone were analyzed. The collected data included
the shape, foramina, canals, fissures, and minute details of
the sphenoid bone. The gained detailed knowledge was
subsequently used to create a 3-D model of the sphenoid
bone with the help of 3-D computer software. A live lecture
was given with this same software and simultaneously
recorded with a microphone and a computer-screen
recorder. A novel approach in lecturing, building the
sphenoid bone from the scratch in a piecemeal fashion,
was utilized.
- RESULTS: The sphenoid bone was recreated as an hor-
izontally elongated box without a superior and posterior
wall. All its foramina, canals, and fissures are visually
easy to follow. Understanding its neuroanatomic termi-
nologies based on their anatomic nature and relationships
is enhanced.
- CONCLUSIONS: This simplified 3-D model, along with
the video lecture, will enhance the efficiency of studying
sphenoid bone anatomy. The educational resources of this
Key words
- Mnemonic
- Neuroanatomy
- Neurosurgery
- Skullbase
- Sphecoid
- Sphenoid bone
- Teaching
Abbreviations and Acronyms
3-D: 3-Dimensional
ICA: Internal carotid artery
e50 www.SCIENCEDIRECT.com WORLD NEUROSURGERY, https://doi.org/10.1016/j.wneu.2019.10.128
study can be obtained by medical students, radiologists,
neurologists, neurosurgeons, neuroscientists, or anyone
else seeking for fundamental understanding of sphenoid
bone anatomy.
INTRODUCTION
A lthough it is critical to appreciate complex neuroanatomic
spatial data for diagnosis and treatment of diseases in the
head and neck area, mentally visualizing neuroanatomic
structures in 3-dimensional (3-D) space tends to be challenging for
medical students, physicians (e.g., neurologists and neuroradiol-
ogists), surgeons (e.g., neurosurgeons and otolaryngologist-sur-
geons), neuroanatomists, and neuroscientists. The ability to
imagine neuroanatomic structures in 3-D space is essential in
order to interpret 2-dimensional cross-sectional slices of the head
and neck in radiographic images (CT and MRI). Understanding
the complex neuroanatomic structures in 3-D space can be chal-
lenging due to the minute details and unparalleled anatomic
complexities present in the head and neck area. Innovative
teaching resources as well as innovative ways of teaching to
facilitate building internal mental models of these complex
neuroanatomic structures is of outmost value to truly comprehend
neuroanatomy and ultimately maintain good patient care.
We built a simplified version of the head and neck anatomy
including the central nervous system. This 3-D model is devoid of
natural irregularities in order to make comprehension and long
term retention of these structures easier. The natural irregularities
of the central nervous system (e.g., irregular pathway of blood
vessels and nerves, odd-shaped brain structures, and irregular
bones) further complicate learning neuroanatomy. Our 3-D model,
called Brainatomy, eradicated these natural irregularities and
Department of Neurosurgery, University Hospital Bochum, Bochum, Germany
To whom correspondence should be addressed: Kadir Er, M.D.
[E-mail: er.kadir.do@gmail.com]
Citation: World Neurosurg. (2020) 135:e50-e70.
https://doi.org/10.1016/j.wneu.2019.10.128
Journal homepage: www.journals.elsevier.com/world-neurosurgery
Available online: www.sciencedirect.com
1878-8750/$ - see front matter ª 2019 Elsevier Inc. All rights reserved.
 ORIGINAL ARTICLE
KADIR ER ET AL. SIMPLIFIED 3-D SPHENOID BONE ANATOMY

WORLD NEUROSURGERY 135: e50-e70, MARCH 2020 www.journals.elsevier.com/world-neurosurgery e51

 ORIGINAL ARTICLE
KADIR ER ET AL. SIMPLIFIED 3-D SPHENOID BONE ANATOMY

Figure 3. Postero-superior view. G.W., greater wing (red); 1., anterior

wall; 2., lateral wall; 3., inferior wall. (Image courtesy of the Rhoton
Collection, AANS/NREF.)
Figure 2. Anterior view of the sphenoid bone. (Image courtesy of the
Rhoton Collection, AANS/NREF.)

consolidating their foundational knowledge of neuroanatomy to

simplified complex neuroanatomic structures and their relation-
ships while maintaining anatomic details and accuracy. This
method makes comprehension and retention of these structures
easier. If you were given the random number 4.98901 to remember
while only the first digit is relevant, most of us would remember
the number 5, as this number is closest to it and easier to
remember. Brainatomy utilizes this pedagogy to reinforce learning
neuroanatomy, that is, extracting key anatomic relationships in
the “neuroanatomy-jungle”. The reader of this paper or the viewer
of the attached video is led through neuroanatomy in a novel
stepwise approach and with simple language in order to appre-
ciate each and every structure and their relationships. The goal of
this 3-D model is to act as a reference model for students in
learning neuroanatomy or dissecting cadavers, for physicians in
localizing lesions and accurately putting diagnosis, for surgeons in
preoperative planing and intraoperative orientation, for neuro-
anatomists in teaching students, and finally for neuroscientists in
enhance their everyday research. This first paper in the series of
Brainatomy describes an innovative and simple technique to un-
derstand and remember the sphenoid bone. This way of teaching
neuroanatomy has already helped numerous students, physicians,
and surgeons.
It is recommended to watch the attached video before reading
this paper. The video can be found at: https://www.youtube.com/
watch?v¼mngfJTAbX88.
METHODS
Various studies on the anatomy of the sphenoid bone were
analyzed. The collected data included the shape, foramina, canals,
fissures, and further minute details of the sphenoid bone.
Furthermore, the meanings of the neuroanatomic terminologies
were researched in literature to gain an in-depth understanding on
how these structures received their names. The gained detailed
knowledge was subsequently used to create a 3-D model of the

Figure 1. Postero-superior view of the sphenoid bone. Visualizing data processing. P.S., planum (“jugum”) sphenoidale;
LB.S., limbus sphenoidalis; P.C.S., prechiasmatic sulcus; T.S., tuberculum sellae; D.S., dorsum sellae; CL., clivus; L.W.,
lesser wing; G.W., greater wing; S.O.F., superior orbital fissure; F.R., foramen rotundum; F.O., foramen ovale; F.S.,
foramen spinosum; P.S.F. and S.P.F., petrosphenoid- and sphenopetrosal fissure; F.L., foramen lacerum; P.C.,
pterygoid (“vidian”) canal, C.S., carotid sulcus; P.F., pterygoid fossa; A.C.P., M.C.P. and P.C.P., anterior, middle, and
posterior clinoid process.(Image courtesy of the Rhoton Collection, AANS/NREF.)

e52 www.SCIENCEDIRECT.com WORLD NEUROSURGERY, https://doi.org/10.1016/j.wneu.2019.10.128


KADIR ER ET AL.
Figure 4. Postero-superior view. B., body of the sphenoid bone (red);
G.W., greater wing. (Image courtesy of the Rhoton Collection,
AANS/NREF.)
sphenoid bone with the help of 3-D computer software (Figure 1).
Additionally, a live lecture was given and simultaneously recorded
with a microphone and a computer-screen recorder. A novel
approach in lecturing, building the sphenoid bone from the
scratch in a piecemeal fashion, was utilized.
RESULTS
The sphenoid bone (os sphenoidale) is often considered to be the
most complex bone in the human body. It is located in the center
of the skullbase and contributes to the middle cranial fossa. The
term sphenoid in Latin describes a wedge shape. This is a trans-
lation error as this bone is not “wedge”-shaped but “wasp”-shaped
(Figures 2 and 40). Wasp in Latin means sphecoid not sphenoid! So
it seems that the sphenoid bone was meant to be called sphecoid
bone as this bone resembles a wasp. We will get back to the wasp
analogy at the end of this article.
Greater Wing (“First Box”)
You can think of the sphenoid bone as a horizontally elongated
box. This box represents the greater wings of the sphenoid bone
(alar major). We propose that the greater wing has an inferior wall
(or floor), an anterior wall (or front wall) and a lateral wall on each
side. This box is lacking a superior wall (or roof) and a posterior
wall (or back wall). The anterior, lateral, and inferior walls
together make up the greater wing on either side—that is, they
look like 2 wings of a “wasp” (sphecoid) (Figure 3). So the gross
WORLD NEUROSURGERY 135: e50-e70, MARCH 2020
ORIGINAL ARTICLE
SIMPLIFIED 3-D SPHENOID BONE ANATOMY
Figure 5. Supero-lateral (top) and lateral (bottom) view. S.T., sella
turcica (red T-shaped outline); H.F., hypophyseal (pituitary) fossa; B.,
body (corpus) of the sphenoid bone; G.W., greater wing. (Image
courtesy of the Rhoton Collection, AANS/NREF.)
shape of the sphenoid bone is basically composed of the greater
wings.
Body of the Sphenoid Bone (“Second Box”)
A second box is centrally placed within the previously mentioned
first box (greater wings). It has the same anterioreposterior
(length) and superioreinferior (height) dimensions as the first
box, but the latero-lateral (width) dimension is considerably nar-
rower. It depicts the body (corpus) of the sphenoid bone (Figure 4).
The remaining three quarters of the sphenoidal body is an air
filled cavity called the sphenoid sinus (sinus sphenoidalis), which
is subdivided into a right and left sinus by the midline septum
called sphenoidal septum (Figures 25 and 26).
Sella Turcica
Next, you can cut out a T-shaped figure from the posterior su-
perior quadrant of the body in the sagital plane. This T-shaped
depression is the “Turkish saddle” (sella turcica), i.e., it resembles a
Turkish saddle used for riding a horse. You can easily remember
www.journals.elsevier.com/world-neurosurgery e53

KADIR ER ET AL.
Figure 6. Supero-lateral (top) and postero-superior (bottom) view. S.T.,
sella turcica; H.F., hypophyseal (pituitary) fossa; B., body (corpus) of the
sphenoid bone; G.W., greater wing; L.W., lesser wing (red). (Image
courtesy of the Rhoton Collection, AANS/NREF.)
the “T”-shaped depression is the “T”-urkish saddle. The inferior
part of the sella turcica (or vertical part of the letter T) is the hy-
pophyseal (pituitary) fossa (fossa hypophysialis) (Figure 5). The
hypophysis or pituitary gland will reside in this fossa. The term
fossa describes a depression.
Lesser Wing
Now add a horizontal roof with a very short anterioreposterior
dimension to the elongated “first box” that was missing a roof.
This is the lesser wing (alar minor). It is called “lesser” it looks like
a thin wing in comparison to the previously described greater wing
(Figure 6).
Anterior Clinoid Process
Let's add a rectangle in the horizontal plane between the lesser
wing (roof of the “first box”) and the body (“second box”). Out of
its 4 edges, its postero-lateral edge is stretched further posteriorly.
This is the anterior clinoid process (processus clinoideus anterior)
(Figure 7). We will be addressing the posterior- and middle
clinoid process later.
Carotid Sulcus
Add a small, flat, and horizontal plane postero-medially on the
superior surface of the floor of the greater wing (“first box”). Its
medial and lateral margins are bent superiorly creating a concave
shape. The lateral segment of this plane is further elongated
e54 www.SCIENCEDIRECT.com WORLD NEUROSURGERY, https://doi.org/10.1016/j.wneu.2019.10.128
ORIGINAL ARTICLE
SIMPLIFIED 3-D SPHENOID BONE ANATOMY
Figure 7. Postero-superior view. A.C.P., anterior clinoid process (red);
L.W., lesser wing; G.W., greater wing. (Image courtesy of the Rhoton
Collection, AANS/NREF.)
posteriorly. This plane is called the carotid sulcus (sulcus caroticus)
(Figure 8). Sulcus in Latin means groove. The internal carotid artery
(ICA) will pass over this sulcus. The posteriorly elongated lateral
segment is called the sphenoidal lingula (lingula sphenoidalis)
(Figure 9). It resembles a tongue, which means lingula in Latin.
The sphenoidal lingula supports the ICA laterally. You can
imagine that this osseous groove is formed by the pulsation of
the artery on the greater wing floor over the years, which leaves
an impression (footprint) on its surface. Similar grooves or sulci
can be found on different sites of the sphenoid bone, or
anywhere else in the human body, any time an pulsating artery
is in contact with bones. For example, we will address the
middle meningeal artery in future papers, which leaves its
footprints on top of the lateral segment of the floor and the
lateral wall of the greater wing as it exits from the foramen
spinosum (Figure 16).
Pterygoid Process (“Third- and Fourth Box”) and Nasopharynx
Now we can add a third and a fourth box on the inferior surface of
the antero-medial part of the greater wings (“first box”). Their
dimensions are identical to the body (second box) except of their
antero-posterior dimension which is half the length of the body of
the sphenoid bone (“second box”). These 2 boxes are lacking a
posterior and inferior wall. They are separated from each other by
a space that could theoretically be filled by just another box of the
same dimensions as the third and fourth box. Along with those
 ORIGINAL ARTICLE
KADIR ER ET AL. SIMPLIFIED 3-D SPHENOID BONE ANATOMY

Figure 8. Postero-lateral view. C.S., carotid sulcus (red); B., body of the Figure 10. Oblique antero-inferior view. P.P., pterygoid process (red);
sphenoid bone; H.F., hypophyseal (pituitary) fossa; G.W., greater wing. P.F., pterygoid fossa; N.P., nasopharynx (blue); B., body of sphenoid
bone (purple); G.W., greater wing.

two boxes it looks like the greater wing is standing on two feet.
The third and fourth box represent the pterygoid processes (Figures 10 and 11). Now you can appreciate how neurosurgerons
(processus pterygoideus). Their medial and lateral walls are called approach tumors residing inside the sella turcica (e.g., pituitary
medial and lateral pterygoid plates, respectively. The space be-
tween the 2 plates is called pterygoid fossa (fossa pterygoidea). The
space between the pterygoid processes (or between the medial
plates of the left and right pterygoid process) is the nasopharynx

Figure 11. Oblique postero-inferior (top) and posterior (bottom) view. M.

P.P. and L.P.P., medial and lateral pterygoid plate; P.F., pterygoid fossa
Figure 9. Postero-superior view. L.S., lingula sphenoidale (red); C.S., (red); N.P., nasopharynx (blue); B., body of sphenoid bone; A.C.P.,
carotid sulcus; B., body of the sphenoid bone; G.W., greater wing. anterior clinoid process; L.W., lesser wing; G.W., greater wing. (Image
(Image courtesy of the Rhoton Collection, AANS/NREF.) courtesy of the Rhoton Collection, AANS/NREF.)

WORLD NEUROSURGERY 135: e50-e70, MARCH 2020 www.journals.elsevier.com/world-neurosurgery e55


KADIR ER ET AL.
Figure 12. Postero-medial view on the right pterygoid process. V.P.,
vaginal process (red); M.P.P. and L.P.P., medial and lateral pterygoid
plate; P.F., pterygoid fossa; N.P., nasopharynx; G.W., greater wing.
adenomas), that is by passing through the nasopharynx and
penetrating the floor of the body of the sphenoid bone to reach
the sella turcica at the posterior-superior quadrant.
Vaginal Process
You can find a small horizontal plate at the most posterior and
superior part of the medial aspect of the medial pterygoid plate. It
is called the vaginal process (processus vaginalis) because we
generated a narrow space above the vaginal process that looks like
a slit (Figure 12).1
Foramina, Canals, and Fissures
You can find several foramina, canals, and fissures on the sphe-
noid bone. They can be remembered from medial to lateral di-
rection. Their names are often given in relation to the structures in
their vicinity, and as such they can easily be remembered after
these relationships are understood.
Optic Canal. The first and most medial one is called optic canal
(canalis opticus). It starts in the most superior, anterior, and lateral
segment of the sella turcica. The canal has a horizontal postero-
medial to antero-lateral direction. It exits the sphenoid body at
the antero-superior quadrant when viewed from sagittal perspec-
tive (Figures 13, 31, and 32). The optic nerve will pass through this
canal. The entrance into this canal is referred to as the optic
foramen (foramen opticum). The above-mentioned trajectory is
aiming the eyeballs, so that the optic nerves can “attach” to them
(Figure 15) .
Superior- and Inferior Orbital Fissure. You can find an elongated gap
between the medial segment of the greater wing (anterior wall)
and the lesser wing (roof). This is the superior orbital fissure
(fissura orbitalis superior) (Figure 13). The term fissure describes
clefts between two bones, in this case the cleft between the
greater- and the lesser wing.
The orbit, where your eyeballs reside, is just in front of the
greater wing (anterior wall), so that this fissure creates a corridor
between the middle cranial fossa (posterior to the greater wing)
e56 www.SCIENCEDIRECT.com WORLD NEUROSURGERY, https://doi.org/10.1016/j.wneu.2019.10.128
ORIGINAL ARTICLE
SIMPLIFIED 3-D SPHENOID BONE ANATOMY
Figure 13. Postero-lateral view. O.C., optic canal; S.O.F., superior orbital
fissure; F.R., foramen rotundum; F.O., foramen ovale; F.L., foramen
lacerum.
and the superior segment of the orbit (anterior to the greater
wing) (Figure 15). This is the reason why the term “superior orbital
fissure” is used. Having a superior orbital fissure predicts the
existence of an inferior one as well. The inferior orbital fissure
(fissura orbitalis inferior) is quite parallel to the superior one but it
is positioned just in front of the inferior margin of the greater
wing (anterior wall). The 2 bones making up this fissure are the
inferior margin of the greater wing (anterior wall) posteriorly
and the maxilla plus zygoma anteriorly (Figure 14). Various
neurovascular structures pass through both fissures.
Foramen Rotundum, Ovale, Spinosum. Next, we have three foramina
in a row on the greater wing (Figure 16). They are aligned in a
diagonal antero-medial to postero-lateral direction and can be
remembered by the acronym R.O.S. We will pass through them
from medial to lateral.
First one is the foramen rotundum. It creates a passage from
posterior to anterior direction within the anterior wall of greater
wing. Rotundum in Latin means round, meaning this foramen has a
round shape. The maxillary nerve passes through this foramen
(Figures 13, 20, 25 and 26).
Second, the foramen ovale, an oval-shaped hole, is in the
middle of our diagonal line. Unlike the foramen rotundum, it
creates a passage from superior to inferior direction and is placed
not in the anterior wall but in the floor of the greater wing. The
mandibular nerve passes through this foramen (Figures 26
and 28).
Third, the foramen spinosum, similarly to the foramen
ovale creates a passage from superior to inferior direction
within the floor of the greater wing. The term spinosum refers to
spine of the sphenoid bone located postero-lateral to this fo-
ramen. This spinous process is the postero-lateral corner of the
floor of the greater wing. The middle meningeal artery passes
through this foramen and is vulnerable for tearing by skullbase
fractures passing through the middle cranial fossa or temple
(pterional) fractures as it passes within the dura mater but
facing the bones. Bleeding from this artery causes blood to
accumulate on top of the dura (epidural hematoma). The

KADIR ER ET AL.
Figure 14. Oblique antero-superior view. S.O.F.,
superior orbital fissure; I.O.F., inferior orbital fissure;
MX., maxilla; ZY., zygoma; PL., palatine bone; G.W.,
pterion is the postero-superior edge of the lateral wall of the
greater wing.
Petrosphenoidal- and Sphenopetrosal Fissure. You can find a fissure
between the floor of the greater wing and the petrous part of the
temporal bone (Figure 17). The terms “petrous” and “sphenoid”
easily predicts where this fissure is located. This fissure is called
the petrosphenoidal fissure. This term is reserved for the fissure
from the superior view. This very same fissure is sometimes
termed the sphenopetrosal fissure when viewed from inferior
(Figure 18). The lesser petrosal nerve passes through this
fissure. This nerve passes over the superior surface of the
petrous bone from posterior to anterior to enter this fissure and
exit the middle cranial fossa. It is called lesser, meaning
smaller, because there is a larger nerve called the greater
petrosal nerve that similarly passes over the superior surface of
the petrous bone.
Foramen Lacerum. The most posterior and medial part of the floor
of the greater wing has a giant foramen called the foramen lac-
erum. It looks lacerated in real life due to its sharp and spiky
margins (Figures 18e20, 30, and 41). The ICA will emerge out of
this foramen from inferior to superior and then pass over the
carotid sulcus as it moves anteriorly.2 The carotid lingula
delineates the lateral border of the ICA as it passes along the
foramen lacerum and carotid sulcus.
Pterygoid (“Vidian”) Canal. In the anterior part within the foramen
lacerum you can find an opening leading to a straight canal that is
oriented from posterior to anterior direction, and it is called the
pterygoid (“vidian”) canal (Figures 18e20, 25, and 26). The term
pterygoid refers to the close proximity of the canal to the
WORLD NEUROSURGERY 135: e50-e70, MARCH 2020
ORIGINAL ARTICLE
SIMPLIFIED 3-D SPHENOID BONE ANATOMY
greater wing; F.R., foramen rotundum; P.C., pterygoid
(“vidian”) canal; P.V.C., palatovaginal (“pharyngeal”)
canal; S.P.F., sphenopalatine foramen.
pterygoid process, specifically to its medial plate which is just
inferior to this canal. The trajectory of this canal is like that of
the foramen rotundum, from posterior to anterior in a
horizontal plane.2,3 The nerve of pterygoid canal (Vidian nerve)
will pass through this canal.
Palatovaginal (“Pharyngeal”)- and Vomerovaginal Canal. Superior to
the vaginal process, but within the medial plate of the pterygoid
process, you can find the vomerovaginal canal (canalis vomer-
ovaginalis) (Figures 21e23). Its trajectory is directed from posterior
to anterior with a slight inferior tilt as it runs anteriorly.1 This
canal has its origin between the alar (wing) of the vomer and
the vaginal process, hence the name vomerovaginal canal
(Figure 23).
Inferior to the vaginal process, but within the medial plate of
the pterygoid process, you can find the palatovaginal canal
(canalis palatovaginalis), also known as pharyngeal canal
(Figures 21e24). Its trajectory is directed from posterior to
anterior with a slight superior tilt as it runs anteriorly.3 It is
termed the palatovaginal canal because it starts at the vaginal
process posteriorly and projects towards the lateral aspect of
the palatine bone anteriorly, hence the name palatovaginal
canal (Figures 23 and 24). This canal is also called the
pharyngeal canal because it connects the nasopharynx (the
space between both pterygoid processes; Figures 10 and 11)
and the pterygopalatine fossa (the space just anterior to the
pterygoid process and lateral to the palatine bone) (Figures 23
and 24). The palatovaginal canal is more consistent than the
vomerovaginal canal.
Due to the opposing tilts of these 2 canals mentioned above
(inferior and superior tilt), they merge anteriorly into 1 canal. It
www.journals.elsevier.com/world-neurosurgery e57
 ORIGINAL ARTICLE
KADIR ER ET AL. SIMPLIFIED 3-D SPHENOID BONE ANATOMY

Figure 15. Oblique antero-superior (top) and anterior
(bottom) view.
OR., orbit (transparent cube); S.O.F., superior orbital
fissure; I.O.F., inferior orbital fissure; MX., maxilla;
ZY., zygoma; PL., palatine bone; G.W., greater wing;
F.R., foramen rotundum; P.C., pterygoid (“vidian”)
canal; P.V.C., palatovaginal (“pharyngeal”) canal; S.P.
F., sphenopalatine foramen. (Image courtesy of the
Rhoton Collection, AANS/NREF.)

e58 www.SCIENCEDIRECT.com WORLD NEUROSURGERY, https://doi.org/10.1016/j.wneu.2019.10.128


KADIR ER ET AL.
Figure 16. Posterior view. F.R., foramen rotundum; F.O., foramen ovale;
F.S., foramen spinosum; PT., pterion (red).
is often described that the more consistent inferiorly placed
palatovaginal canal is joined by the relatively inconsistent su-
periorly placed vomeropalatine canal, so that the exiting point
of both canals on the anterior surface of the medial plate of the
pterygoid process is often referred to as the palatovaginal canal,
not the vomerovaginal canal (Figures 22e24).
Diagonal Ventral Foramina. The last 3 foramina or canals seen from
anterior view follow a diagonal line that goes from the superiore
lateral to the inferioremedial direction. Laterally, there is the fo-
ramen rotundum, in the middle there is the pterygoid (“vidian”)
canal, and finally most medially you can find the palatovaginal
(“pharyngeal”) canal (Figures 20 and 24e26).
Sphenoidal Aperture, Sinus and Septum
There are 2 openings on the anterior aspect of the sphenoid body.
They are called sphenoidal apertures (apertura sinus sphenoidalis).
These apertures open up into the sphenoidal sinus, which is the
hollow inner space of the sphenoidal body. They belong to the
collection of the paranasal sinuses. The sinus is split into a left
and right one by a midline septum called the sphenoidal septum
(Figures 25 and 26).4
Additionally there is a superficial vertical ridge between the two
apertures called the sphenoidal crest. The most inferior end of
this crest is called the sphenoidal rostrum (Figure 26). Rostrum in
Latin means towards the nose. This point is directed towards
the nose of the human body.
Planum (Jugum) Sphenoidale
While the posterior half of the superior surface of the body of the
sphenoid bone forms the T-shaped sella turcica, the anterior half
is quite flat and it is called planum or jugum sphenoidale.5 Think
of a carpet overlying the body of the sphenoid bone just in front of
the Turkish saddle (Figure 27). Skullbase meningiomas commonly
arise from the planum sphenoidale.6 Jugum in Latin refers to a
WORLD NEUROSURGERY 135: e50-e70, MARCH 2020
ORIGINAL ARTICLE
SIMPLIFIED 3-D SPHENOID BONE ANATOMY
groove connecting 2 structures, in this case this place or groove
connects the left- and the right lesser wing (Figure 6).
Prechiasmatic Sulcus
The anterior part of the upper half of the sella turcica (or hori-
zontal part of the letter “T”) is called the prechiasmatic sulcus
(sulcus prechiamaticus) (Figure 5). The optic chiasma sits before and
on top of this sulcus (i.e., the prefix “pre-” predicts that this sulcus
is anterior to the optic chiasma) (Figure 28).
Hypophyseal (Pituitary) Fossa
The inferior half of the sella turcica (or vertical part of the letter
“T”) is called the hypophyseal or pituitary fossa (fossa hypophysialis)
(Figure 5). This is where the pituitary gland resides (Figures 29 and
31e34).
Dorsum Sellae
The posterior segment of the sella turcica is called the dorsum
sellae (i.e., the dorsal part of the Turkish saddle) (Figure 29). It is
the posterior wall of the hypophyseal fossa.
Clivus
The dorsum sellae continues inferiorly as the clivus (Figure 30).
The occipital bone is attached to the sphenoid bone at the
inferior margin of the sphenoidal clivus and contributes to the
formation of the clivus inferiorly. So the superior part of the
clivus is made up of the sphenoid bone and the inferior part of
the clivus is made up of the occipital bone. This centrally placed
region is clinically highly relevant since chordomas, metastatic
tumors, and fibrous dysplasia can occur here.7
Anterior, Middle, and Posterior Clinoid Process
As previously discussed, you can find a horizontal rectangle be-
tween the lesser wing (short roof) and the centrally placed body.
The lateral side of the rectangle is longer than its medial side. This
structure is the anterior clinoid process (processus clinoideus anterior)
(Figures 7 and 31).
The postero-superior corner of the hypophyseal fossa or the
antero-lateral corner of the dorsum sellae is called the posterior
clinoid process (processus clinoideus posterior) (Figure 32).
The antero-superior corner of the hypophyseal fossa, opposing
the posterior clinoid process, is the middle clinoid process (proc-
essus clinoideus medius) (Figure 33). The presence of this structure is
inconsistent.8 It is called “middle” because it is located between
the anterior and posterior clinoid process. The term clinoid in
Latin means curved or hook-like (i.e., all 3 of these bony promi-
nences resemble a hook).
Limbus Sphenoidale
The ridge at the posterior border of the planum sphenoidale or the
superior border of the prechiasmatic sulcus is called limbus
sphenoidale (Figure 34). Limbus in Latin means border. As this
structure demarcates the border between the planum
sphenoidale and the prechiasmatic sulcus, it separates the
www.journals.elsevier.com/world-neurosurgery e59

KADIR ER ET AL.
Figure 17. Oblique postero-superior (top) and
postero-superior (bottom) view on middle cranial
fossa. P.S.F., petrosphenoid fissure (red); P.B.,
petrous bone; F.R., foramen rotundum; F.O., foramen
anterior cranial fossa from the middle cranial fossa.9 Similarly the
posterior margin of the lesser wing (“roof”) is referred to as
sphenoid ridge, it demarcates the border between the
anterior- and middle cranial fossa (Figure 6). When
meningiomas arise at the sphenoid ridge they are called
sphenoid ridge meningiomas.
e60 www.SCIENCEDIRECT.com WORLD NEUROSURGERY, https://doi.org/10.1016/j.wneu.2019.10.128
ORIGINAL ARTICLE
SIMPLIFIED 3-D SPHENOID BONE ANATOMY
ovale; F.S., foramen spinosum; A.C.P., anterior clinoid
process; L.W., lesser wing; G.W., greater wing; B.,
body of sphenoid bone. (Image courtesy of the Rhoton
Collection, AANS/NREF.)
Tuberculum Sellae
The bulging between the prechiasmatic sulcus and the hypophy-
seal fossa is called the tuberculum sellae (Figure 35). Tuberculum in
Latin means an elevation. This is a common site of origin for
skullbase meningiomas (referred to as tuberculum sellae
meningioma).6

KADIR ER ET AL.
Figure 18. Postero-superior view. P.S.F. and S.P.F., petrosphenoid- and
sphenopetrous fissure (red); F.R., foramen rotundum; F.L., foramen
lacerum; O.C., optic canal; S.O.F., superior orbital fissure.
Interclinoid Bridge
Sometimes you can find a osseous bridge or connection between
the anterior and middle clinoid process. This structure is intui-
tively referred to as the interclinoid bridge (Figure 36).8
Caroticoclinoid Foramen
The presence of the interclinoid bridge generates a foramen. This
foramen is outlined by the interclinoid bridge posteriorly, pre-
chiasmatic sulcus infero-medially, and the anterior clinoid process
supero-laterally. The ICA will pass through this foramen. The
foramen is called caroticoclinoid foramen, referring to the inter-
clinoid bridge posteriorly and the ICA that passes through it
(Figure 37).8
Proximal- and Distal Carotid Ring
The dura overlying the anterior clinoid process on its superior and
inferior surface extends medially over the caroticoclinoid foramen
Figure 19. Postero-superior view. F.L., foramen lacerum (red); C.S.,
carotid sulcus; L.S., lingula sphenoidalis; G.W., greater wing; F.R.,
foramen ovale; B., body of sphenoid bone.
WORLD NEUROSURGERY 135: e50-e70, MARCH 2020
ORIGINAL ARTICLE
SIMPLIFIED 3-D SPHENOID BONE ANATOMY
Figure 20. Posterior view on foramen lacerum. P.C., pterygoid (“vidian”)
canal (red), F.R., foramen rotundum; C.S., carotid sulcus; G.W., greater
wing; P.P., pterygoid process; V.P., vaginal process; B., body of
sphenoid bone.
to attach to the tuberculum sellae and prechiasmatic sulcus. These
2 layers of dura are penetrated by the ICA while it passes through
the caroticoclinoid foramen from inferior to superior direction
(Figure 37). Each layer of dura (superior and inferior) will form a
ring around the ICA.5,10 The inferiorly located dural layer
generates a ring that is called the proximal or inferior carotid
ring and the superiorly located dural layer generates a ring that
is called distal or superior carotid ring (Figure 38). The terms
proximal and distal are used in reference to the direction of the
ICA, which ascends from inferior to superior at this region. The
dura extending medially from the superior surface of the
anterior clinoid process forms the distal carotid ring. The dura
extending medially from the inferior surface of the anterior
clinoid process forms the proximal carotid ring; at the same
time the dura wraps around the ICA superiorly and encase the
ICA until the ICA passes through the distal carotid ring. This
segment of the dura wrapping around the ICA is called the
Figure 21. Postero-medial view on the medial pterygoid plate. V.V.C. and
P.V.C., vomerovaginal and palatovaginal canal (red); V.P., vaginal
process; M.P.P., medial pterygoid plate; G.W., greater wing.
www.journals.elsevier.com/world-neurosurgery e61

KADIR ER ET AL.
Figure 22. Anterior view on the medial pterygoid plate. V.V.C.,
vomerovaginal canal entrance; P.V.C., palatovaginal canal entrance and
exit (red dashed circle); V.P., vaginal process.
carotid collar. The term collar in Latin means necklace (i.e., the
ICA has a necklace between the proximal and distal carotid
ring). The ICA inferior to the distal carotid ring is in the
extradural space. The ICA superior to the distal carotid ring is
in the intradural space. Thus the ICA enters the intradural space
after passing the distal carotid ring.10 This key fact about the
distal carotid ring is clinically highly relevant in
terms of aneurysms. An ICA aneurysm inferior to
the distal carotid ring will not cause subarachnoid
hemorrhage, whereas an ICA aneurysm superior to
the distal carotid ring will cause subarachnoid
Video available at
hemorrhage when ruptured. An in-depth review www.sciencedirect.com
Figure 23. Posterior view on the nasopharynx. V.V.C.
and P.V.C., vomerovaginal- and palatovaginal canal;
e62 www.SCIENCEDIRECT.com WORLD NEUROSURGERY, https://doi.org/10.1016/j.wneu.2019.10.128
ORIGINAL ARTICLE
SIMPLIFIED 3-D SPHENOID BONE ANATOMY
along with simplified figures regarding the above mentioned
carotid rings will be given in a separate paper.
Optic Strut
The lateral wall or column of the optic canal is called the optic
strut (Figure 39).5 Strut in Latin describes a supportive structure, so
you can think of the optic strut as a supporting column of the
lateral part of the planum sphenoidale or the medial part of the
anterior clinoid process (Figure 36). You may want to
decompress the optic canal (e.g., due to an ophthalmic
aneurysm or tumor compressing the optic nerve in this closed
bony canal) by first removing the anterior clinoid process
(clinoidectomy) and subsequently removing the optic strut. This
will superiorly (anterior clinoid process) and laterally (optic
strut) decompress the optic canal.
Wasp Analogy (Sphecoid)
Back to the wasp analogy. Sphecoid in Latin means wasp. The wings
of the wasp are the greater and lesser wings. The eyes of the wasp
are the superior orbital fissures. The head of the wasp is the body
of the sphenoid bone. Finally, the legs of the wasp are the 2
pterygoid processes (Figure 40). A final overview is provided in
Figure 41.
CONCLUSIONS
This simplified 3-D model and the corresponding
video lecture will enhance the efficiency of studying
sphenoid bone anatomy (Video 1). The educational
resources of this study can be obtained by medical
students, radiologists, neurologists, neurosurgeons,
neuroscientists, or anyone else seeking for
VM., vomer; A.VM., alar (wing) of vomer; PL., palatine
bone; S.P.F., sphenopalatine foramen.

KADIR ER ET AL.
Figure 24. Anterior view on the palatine bone. PL., palatine bone; VM.,
vomer; F.R., foramen rotundum. P.C., pterygoid (“vidian”) canal; P.V.C.,
palatovaginal (pharyngeal) canal; S.P.F., sphenopalatine foramen; F.O.,
foramen ovale; F.S., foramen spinosum. (Image courtesy of the Rhoton
Collection, AANS/NREF.)
Figure 25. Anterior view on the sphenoid bone. F.R., foramen rotundum.
P.C., pterygoid (“vidian”) canal; P.V.C., palatovaginal (pharyngeal) canal;
G.W., greater wing; S.A., sphenoidal aperture, S.S. sphenoidal septum;
P.P., pterygoid process.
WORLD NEUROSURGERY 135: e50-e70, MARCH 2020
ORIGINAL ARTICLE
SIMPLIFIED 3-D SPHENOID BONE ANATOMY
Figure 26. Antero-inferior (top) and anterior (bottom) view on the
sphenoid bone. S.C., sphenoidal crest; S.R., sphenoidal rostrum; S.A.,
sphenoidal aperture; S.O.F., superior orbital fissure; P.P., pterygoid
process; F.R., foramen rotundum. P.C., pterygoid (“vidian”) canal;
P.V.C., palatovaginal (pharyngeal) canal; F.O., foramen ovale; F.S.,
foramen spinosum; V.P., vaginal process. (Image courtesy of the Rhoton
Collection, AANS/NREF.)
Figure 27. Posterior view. P.S., planum (“jugum”) sphenoidale; O.C.,
optic canal; A.C.P., anterior clinoid process; F.R., foramen rotundum;
L.W., lesser wing; G.W., greater wing.
www.journals.elsevier.com/world-neurosurgery e63

KADIR ER ET AL.
Figure 28. Postero-medial view. P.C.S., prechiasmatic sulcus; P.S.,
planum (“jugum”) sphenoidale; O.C., optic canal; A.C.P., anterior clinoid
process; F.O., foramen ovale; L.W., lesser wing; G.W., greater wing.
fundamental understanding of sphenoid bone anatomy. Future
videos and papers with similar pedagogy will follow soon. They
will simplify different aspects of neuroanatomy including
Figure 29. (A) Medial view. H.F., hypophyseal (pituitary) fossa; P.C.S.,
prechiasmatic sulcus; P.S., planum (“jugum”) sphenoidale; O.C., optic
canal; A.C.P., anterior clinoid process; F.S., foramen spinosum; B., body
of sphenoid bone. (B) Postero-medial view. D.S., dorsum sellae; H.F.,
hypophyseal (pituitary) fossa; P.C.S., prechiasmatic sulcus; O.C., optic
canal; A.C.P., anterior clinoid process; O.C., optic canal.
e64 www.SCIENCEDIRECT.com WORLD NEUROSURGERY, https://doi.org/10.1016/j.wneu.2019.10.128
ORIGINAL ARTICLE
SIMPLIFIED 3-D SPHENOID BONE ANATOMY
Figure 30. Postero-inferior view. CL., clivus; D.S., dorsum sellae; B.,
body of sphenoid bone; P.C., pterygoid (“vidian”) canal; L.S., lingula
sphenoidalis; L.W., lesser wing; A.C.P., anterior clinoid process.
osteology of all skull bones, superficial and deep central nervous
system structures, neurovascular structures, and various surgical
trajectories.
Figure 31. Postero-superior view. A.C.P., anterior clinoid process; P.S.,
planum (“jugum”) sphenoidale; P.C.S., prechiasmatic sulcus; H.F.,
hypophyseal (pituitary) fossa; D.S., dorsum sellae; CL., clivus; F.R.,
foramen rotundum; F.O., foramen ovale; S.O.F., superior orbital fissure;
L.W., lesser wing; C.S., carotid sulcus, F.L., foramen lacerum.
 ORIGINAL ARTICLE
KADIR ER ET AL. SIMPLIFIED 3-D SPHENOID BONE ANATOMY

Figure 32. Postero-medial view. P.C.P., posterior clinoid process; P.C.S., Figure 35. Postero-medial view. T.S., tuberculum sellae; LB.S., limbus
prechiasmatic sulcus; H.F., hypophyseal (pituitary) fossa; D.S., dorsum sphenoidalis; A.C.P. and M.C.P., anterior- and middle clinoid process;
sellae; S.O.F., superior orbital fissure. P.S., planum (“jugum”) sphenoidale, P.C.S., prechiasmatic sulcus; O.C.,
optic canal; H.F., hypophyseal (pituitary) fossa; F.O., foramen ovale.

Figure 33. Supero-medial view. A.C.P., M.C.P., P.C.P., anterior, middle, Figure 36. Postero-medial view. IC.B., interclinoid bridge; A.C.P., M.C.P.
and posterior clinoid process; P.S., planum (“jugum”) sphenoidale, and P.C.P., anterior, middle, and posterior clinoid process; LB.S., limbus
P.C.S., prechiasmatic sulcus; H.F., hypophyseal (pituitary) fossa; D.S., sphenoidalis; P.S., planum (“jugum”) sphenoidale, P.C.S., prechiasmatic
dorsum sellae. sulcus; T.S., tuberculum sellae; H.F., hypophyseal (pituitary) fossa.

Figure 34. Postero-medial view. LB.S., limbus sphenoidalis; A.C.P. and

M.C.P., anterior- and middle clinoid process; P.S., planum (“jugum”)
sphenoidale, P.C.S., prechiasmatic sulcus; O.C., optic canal; H.F.,
hypophyseal (pituitary) fossa; F.O., foramen ovale.

WORLD NEUROSURGERY 135: e50-e70, MARCH 2020 www.journals.elsevier.com/world-neurosurgery e65

 ORIGINAL ARTICLE
KADIR ER ET AL. SIMPLIFIED 3-D SPHENOID BONE ANATOMY

Figure 37. Postero-medial (top) and postero-superior limbus sphenoidalis; P.C.S., prechiasmatic sulcus; T.S.
(bottom) view. C.C.F., caroticoclinoid foramen; IC.B., , tuberculum sellae; F.O., foramen ovale. (Image
interclinoid bridge; A.C.P. and courtesy of the Rhoton Collection, AANS/NREF.)
M.C.P., anterior and middle clinoid process; LB.S.,

e66 www.SCIENCEDIRECT.com WORLD NEUROSURGERY, https://doi.org/10.1016/j.wneu.2019.10.128

 ORIGINAL ARTICLE
KADIR ER ET AL. SIMPLIFIED 3-D SPHENOID BONE ANATOMY

Figure 38. Postero-lateral view. S.C.C. and I.C.C., superior and inferior
carotid collar; C.C.F., caroticoclinoid foramen; A.C.P. and M.C.P.,
anterior and middle clinoid process; P.S., planum (“jugum”) sphenoidale;
LB.S., limbus sphenoidalis; P.C.S., prechiasmatic sulcus; T.S.,
tuberculum sellae; O.C., optic canal.

Figure 39. Postero-lateral (top) and right-lateral (bottom) view. O.S.,

optic strut; O.C., optic canal; S.C.C. and I.C.C., superior- and inferior
carotid collar; C.C.F., caroticoclinoidal foramen; IC.B., interclinoid bridge;
M.C.P., middle clinoid process; LB.S., limbus sphenoidalis; P.C.S.,
prechiasmatic sulcus; T.S., tuberculum sellae. (Image courtesy of the
Rhoton Collection, AANS/NREF.)

WORLD NEUROSURGERY 135: e50-e70, MARCH 2020 www.journals.elsevier.com/world-neurosurgery e67

 ORIGINAL ARTICLE
KADIR ER ET AL. SIMPLIFIED 3-D SPHENOID BONE ANATOMY

Figure 40. Sphenoid bone. (top left) Anterior view; (top right) right lateral view; (bottom right) Posterior view;
(bottom right) Postero-superior view. (Image courtesy of the Rhoton Collection, AANS/NREF.)

e68 www.SCIENCEDIRECT.com WORLD NEUROSURGERY, https://doi.org/10.1016/j.wneu.2019.10.128


KADIR ER ET AL.
Figure 41. Postero-superior view. P.S., planum (“jugum”) sphenoidale; LB.
S., limbus sphenoidalis; P.C.S., prechiasmatic sulcus; T.S., tuberculum
sellae; D.S., dorsum sellae; CL., clivus; L.W., lesser wing; G.W., greater
wing; S.O.F., superior orbital fissure; F.R., foramen rotundum; F.O.,
foramen ovale; F.S., foramen spinosum; P.S.F. and S.P.F.,
WORLD NEUROSURGERY 135: e50-e70, MARCH 2020
ORIGINAL ARTICLE
SIMPLIFIED 3-D SPHENOID BONE ANATOMY
petrosphenoid- and sphenopetrosal fissure; F.L., foramen lacerum;
P.C., pterygoid (“vidian”) canal, C.S., carotid sulcus; P.F., pterygoid fossa;
A.C.P., M.C.P. and P.C.P., anterior, middle, and posterior clinoid process.
(Image courtesy of the Rhoton Collection, AANS/NREF.)
www.journals.elsevier.com/world-neurosurgery e69

KADIR ER ET AL.
REFERENCES
1. Meng Q, Lu Y, Shi L, Lei Y. Simultaneous obser-
vation and discrimination of palatovaginal and
vomerovaginal canals by transverse CT. Int J Clin
Exp Med. 2015;8:15601-15610.
2. Wang W, Lieber S, Mathias RN, et al. The fora-
men lacerum: surgical anatomy and relevance for
endoscopic endonasal approaches. J Neurosurg.
2018;6:1-12.
3. Cheng Y, Gao H, Song G, Li Y, Zhao G.
Anatomical study of pterygoid canal (PC) and
palatovaginal canal (PVC) in endoscopic trans-
sphenoidal approach. Surg Radiol Anat. 2016;38:
541-549.
4. Fujii K, Chambers SM, Rhoton AL. Neurovascular
relationships of the sphenoid sinus. J Neurosurg.
1979;50:31-39.
e70 www.SCIENCEDIRECT.com
SIMPLIFIED 3-D SPHENOID BONE ANATOMY
5. Joo W, Funaki T, Yoshioka F, Rhoton AL. Micro-
surgical anatomy of the carotid cave. Oper Neuro-
surg. 2012;70(2 Suppl):ons300-ons312.
6. Abbassy M, Woodard TD, Sindwani R,
Recinos PF. An overview of anterior skull base
meningiomas and the endoscopic endonasal
approach. Otolaryngol Clin North Am. 2016;49:
141-152.
7. Hofmann E, Prescher A. The clivus: anatomy,
normal variants and imaging pathology. Clin
Neuroradiol. 2012;22:123-139.
8. Dagtekin A, Avci E, Uzmansel D, et al. Micro-
surgical anatomy and variations of the anterior
clinoid process. Turk Neurosurg. 2014;24:484-493.
9. Kerr RG, Tobler WD, Leach JL, et al. Anatomic
variation of the optic strut: classification schema,
radiologic evaluation, and surgical relevance.
J Neurol Surgery, B Skull Base. 2012;73:424-429.
WORLD NEUROSURGERY, https://doi.org/10.1016/j.wneu.2019.10.128
ORIGINAL ARTICLE
10. Seoane E, Rhoton AL, De Oliveira E. Microsur-
gical anatomy of the dural collar (carotid collar)
and rings around the clinoid segment of the in-
ternal carotid artery. Neurosurgery. 1998;42:
869-886.
Conflict of interest statement: The authors declare that the
article content was composed in the absence of any
commercial or financial relationships that could be construed
as a potential conflict of interest.
Received 21 August 2019; accepted 21 October 2019
Citation: World Neurosurg. (2020) 135:e50-e70.
https://doi.org/10.1016/j.wneu.2019.10.128
Journal homepage: www.journals.elsevier.com/world-
neurosurgery
Available online: www.sciencedirect.com
1878-8750/$ - see front matter ª 2019 Elsevier Inc. All
rights reserved.