gms | German Medical Science

ESBS 2005: Skull Base Surgery: An Interdisciplinary Challenge
7th Congress of the European Skull Base Society held in association with
the 13th Congress of the German Society of Skull Base Surgery

18. - 21.05.2005, Fulda, Germany

The greater superficial petrosal/vidian nerve: imaging, anatomy, and pathology

Meeting Contribution

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  • Arthur B. Dublin - Department of Radiology, University of California, Davis, Medical Center, USA
  • Paul J. Donald - Department of Otolaryngology, University of California, Davis, Medical Center, USA

ESBS 2005: Skull Base Surgery: An Interdisciplinary Challenge. 7th Congress of the European Skull Base Society held in association with the 13th Congress of the German Society of Skull Base Surgery. Fulda, 18.-21.05.2005. Düsseldorf: German Medical Science GMS Publishing House; 2009. Doc05esbs03

doi: 10.3205/05esbs03, urn:nbn:de:0183-05esbs034

Published: January 27, 2009

© 2009 Dublin et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



The vidian nerve is the distal anterior branch of the greater superficial petrosal nerve (GSPN), the latter a branch of the seventh nerve. The GSPN contains parasympathetic fibers for lacrimation, and originates from the seventh nerve geniculate ganglion. The GSPN courses anteriorly along side the petrous bone, usually separate from the petrous carotid canal. The GSP continues underneath the fifth nerve ganglion toward the foramen lacerum where the GSPN picks up sympathetic fibers (which will in turn innervate the nasopharynx and nasal cavity mucosa) from the deep petrosal nerve. The GSPN then enters the vidian bony canal, where the term the vidian nerve is used. The vidian nerve then courses anteriorly through this canal to anatomose with the pterygopalatine ganglion in the sphenopalatine canal, and through fifth nerve fibers, supplies parasympathetic control to the lacrimal glands and sympathetic secretion control to the nasopharynx and nasal cavity [1], [2].

The vidian canal is part of the sphenoid bone, and runs from posterior to anterior medial and caudal to foramen rotundum. Anteriorly, the canal opens into the spheno-maxillary space to connect to the petrosal ganglion. Therefore, this canal and nerve present a pathway for the spread of infection and neoplasia, sometimes invading the cavernous sinus due to its proximity of the GSPN/vidian nerve to Meckel’s cave (the GSPN runs underneath the fifth nerve ganglion) [1]. More proximal spread of disease into the seventh nerve may occur with resulting and puzzling facial paralysis.

The blood supply to the vidian nerve arises from small branches of the carotid artery, mostly prominently at the level of foramen spinosum. This vessel may be enlarged with a variety of skull base/nasopharyngeal tumors, particular with juvenile angiofibroma. One must be careful when embolizing such vascular neoplasms to avoid reflux of embolic particles through the tumor, through the vidian artery, and into the internal carotid artery [1].

The distance between the vidian canal and the foramen rotundum has been measured to evaluate sphenoid mucocele expansion. This distance should not exceed 11.4 mm [3]. One report describes definite elevations of the vidian canal into the base of the sphenoid sinus [4]. However, an analysis of 100 consecutive coronal sinus CT scans at UC Davis (Dublin, 2005) showed that 70% are fully buried in the sphenoid bone beneath the sphenoid sinus, while 17.5% made a definite impression in the sphenoid sinus floor, and 12.5% presented as a “stalk” into the sinus.

Dysfunction of the vidian nerve may occur, either due to trauma, infection, tumor, psychogenic syndromes, methyldopa use, rauwolfia use, endrocrine disorders, and idiopathic causes. The syndrome of dysfunction involves increased parasympathetic and decreased sympathetic control, resulting in vasodilatation, hypersecretion, and chronic and prolonged sneezing. Various approaches have been used to sever the nerve, including the classic transantral, subperiosteal transantral, transpalatal, transethmoidal, and transnasal approaches [5].


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