Clivus (anatomy)

Bony part of the skull base

Clivus

Superior view of the clivus

Details
Identifiers
Latin| clivus
TA98| A02.1.00.051
A02.1.04.006
TA2| 454
FMA| 54376
Anatomical terms of bone

[edit on Wikidata]

The clivus (/ˈklaɪvəs/,[1] Latin for "slope") or Blumenbach clivus is a part of the occipital bone at the base of the skull,[2] extending anteriorly from the foramen magnum. It is related to the pons and the abducens nerve (CN VI).

The term is also used for the clivus ocularis, an unrelated feature of the retina.

## Structure

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The clivus is a shallow depression behind the dorsum sellae of the sphenoid bone, extending inferiorly to the foramen magnum.[3] It slopes gradually to the anterior part of the basilar occipital bone at its junction with the sphenoid bone. Synchondrosis of these two bones forms the clivus. On axial planes, it sits just posterior to the sphenoid sinuses. It is medial to the foramen lacerum and proximal to the anastomosis of the internal carotid artery with the Circle of Willis. (The artery reaches the middle cranial fossa above the foramen lacerum). It is anterior to the basilar artery. On sagittal plane, it can be divided into two surfaces, the pharyngeal (inferior) surface and basilar (superior) surface. A small elevation known as the pharyngeal tubercle is present on the inferior surface for the fibrous pharyngeal raphe to attach.[4]

The pons sits on the basilar surface of the clivus.[3] The abducens nerve (CN VI) also tracks along the clivus during its course.[3]

### Variations

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During embryonic development, the clivus is formed by the sphenooccipital synchondrosis: fusion of the basiocciput and basisphenoid. When the fusion occurs improperly, it can give rise to gaps that are considered anatomical variations. Variations of the clivus include fossa navicularis magna, craniopharyngeal canal, canalis basilaris medianus, and transverse basilar fissure (Saucer's fissure).[5] Ossification of the apical ligament of dens may also occur, resulting in a variant bony tubercle at the inferior end of the clivus.[5] Two further variations, of possibly other etiology, are found at the lower end of the clivus: condylus tertius and arcus praebasiocipitalis. Ecchordosis physaliphora, a congenital benign lesion derived from the notochord, can occur in the dorsal part of the clivus.[6]

In 2023, variant tubercles and eminences have been found on the basilar surface of the clivus in around 10% of the general population. The terms "basilar tubercles / eminences of the clivus" have been coined to described these newly discovered structures.[7]

## Clinical importance

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The abducens nerve (CN VI) tracks along the clivus during its course.[3] Increased intracranial pressure can trap the nerve at this point and cause signs of palsy.

The clivus is also the site for chordoma, a rare type of cancer.

### Surgery

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Surgery for lesions involving the clivus and surrounding structures have traditionally been approached via extended subfrontal transbasal, anterior transfacial, lateral transtemporal, far-lateral approaches, and staged approaches.[8] These approaches are limited in that they often require extensive bone removal and brain retraction while placing critical neurovascular structures between the surgeon and the site of pathology. It has been proposed that these limitations are mitigated by significant advancements in the use of endoscopic endonasal surgery. Contemporary surgical approaches involving extended endoscopic endonasal approaches to the clivus have been increasingly described by several groups, and have been shown to be a safe and effective strategy for the surgical management of a variety of benign and malignant lesions.[8]

### Relation of the clivus and dens

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The clivus is an important landmark for checking for anatomical atlanto-occipital alignment. When viewed on a lateral C-spine radiograph, the clivus forms a line which, if extended, is known as Wackenheim's clivus line. Wackenheim's clivus line should pass through the dens of the axis or be tangential to it.[9]

## History

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"Clivus" is also used as an abbreviated term for the clivus ocularis, which is the sloping inner wall of the retina as it dips into the foveola in the macula of the eye. To disambiguate, the clivus is sometimes referred to as the Blumenbach clivus. This is named after Johann Friedrich Blumenbach.[citation needed]

## Additional images

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* Clivus

* Clivus

## See also

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* Pharyngeal tubercle

## References

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This article incorporates text in the public domain from page 148 of the 20th edition of Gray's Anatomy (1918)

1. ^ "Definition of clivus | Dictionary.com". www.dictionary.com. Retrieved 2022-01-05.
2. ^ Drake, Richard L. Gray's Anatomy for Students 3rd Ed. p. 868.
3. ^ a b c d Maira, Giulio; Doglietto, Francesco; Pallini, Roberto (2012). "41 - Surgical Management of Lesions of the Clivus". Schmidek and Sweet Operative Neurosurgical Techniques (6th ed.). Saunders. pp. 486–500\. doi:10.1016/B978-1-4160-6839-6.10041-3. ISBN 978-1-4160-6839-6.
4. ^ Jhawar, Sukhdeep Singh; Nunez, Maximiliano; Pacca, Paolo; Voscoboinik, Daniel Seclen; Truong, Huy (2016-10-01). "Craniovertebral junction 360°: A combined microscopic and endoscopic anatomical study". Journal of Craniovertebral Junction and Spine. 7 (4): 204–216\. doi:10.4103/0974-8237.193270. ISSN 0974-8237. PMC 5111321. PMID 27891029.
5. ^ a b Hofmann, E.; Prescher, A. (2012-06-01). "The Clivus". Clinical Neuroradiology. 22 (2): 123–139\. doi:10.1007/s00062-011-0083-4. ISSN 1869-1447. PMID 21710384. S2CID 26436019.
6. ^ Lagman, Carlito; Varshneya, Kunal; Sarmiento, J. Manuel; Turtz, Alan R.; Chitale, Rohan V. (2016-03-30). "Proposed Diagnostic Criteria, Classification Schema, and Review of Literature of Notochord-Derived Ecchordosis Physaliphora". Cureus. 8 (3): e547. doi:10.7759/cureus.547. ISSN 2168-8184. PMC 4854633. PMID 27158576.
7. ^ Tangrodchanapong, Taweesak; Yurasakpong, Laphatrada; Suwannakhan, Athikhun; Chaiyamoon, Arada; Iwanaga, Joe; Tubbs, R. Shane (2023-10-01). "Basilar tubercles and eminences of the clivus: Novel anatomical entities". Annals of Anatomy - Anatomischer Anzeiger. 250: 152133. doi:10.1016/j.aanat.2023.152133. ISSN 0940-9602. PMID 37460045. S2CID 259947619.
8. ^ a b Little, Ryan E.; Taylor, Robert J.; Miller, Justin D.; Ambrose, Emily C.; Germanwala, Anand V.; Sasaki-Adams, Deanna M.; Ewend, Matthew G.; Zanation, Adam M. (August 2014). "Endoscopic endonasal transclival approaches: case series and outcomes for different clival regions". Journal of Neurological Surgery. Part B, Skull Base. 75 (4): 247–254\. doi:10.1055/s-0034-1371522. ISSN 2193-6331. PMC 4108492. PMID 25093148.
9. ^ McKenna DA, Roche CJ, Lee KW, Torreggiani WC, Duddalwar VA. Atlanto-occipital dislocation: case report and discussion. Can J Emerg Med 2006; 8(1):50-3. Available at: link Archived 2007-09-27 at the Wayback Machine and link Archived 2007-09-27 at the Wayback Machine. Accessed on: December 7, 2006.

## External links

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* Anatomy photo:22:os-0913 at the SUNY Downstate Medical Center - "Osteology of the Skull: Internal Surface of Skull"
* Diagram at uwo.ca

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Neurocranium of the skull

Occipital|

| Squamous part|

* external
* Inion/External occipital protuberance
* Occipital bun
* External occipital crest
* Nuchal lines
* Suprainiac fossa
* planes
* Occipital
* Nuchal
* internal
* Cruciform eminence
* Internal occipital protuberance
* Internal occipital crest
* Groove for transverse sinus

|

Lateral parts|

* Condyle
* Condyloid fossa
* Condylar canal
* Hypoglossal canal
* jugular
* Jugular process
* Jugular tubercle

Basilar part|

* Pharyngeal tubercle
* Clivus

Other|

* Foramen magnum
* Basion
* Opisthion

Parietal|

* Parietal eminence
* Temporal line
* Parietal foramen
* Sagittal sulcus
* Sagittal keel
* Sagittal crest

Frontal|

| Squamous part|

* Frontal suture
* Frontal eminence
* external
* Superciliary arches
* Glabella
* foramina
* Supraorbital foramen
* Brow ridge
* Foramen cecum
* Zygomatic process
* internal
* Sagittal sulcus
* Frontal crest

|

Orbital part|

* Ethmoidal notch
* Fossa for lacrimal gland
* Trochlear fovea
* Frontal sinus
* Frontonasal duct

Temporal|

| Squamous part|

* Articular tubercle
* Suprameatal triangle
* Mandibular fossa
* Petrotympanic fissure
* Zygomatic process

|

Mastoid part|

* Mastoid foramen
* Mastoid process (Mastoid cells)
* Mastoid notch
* Occipital groove
* Sigmoid sulcus
* Mastoid antrum (Aditus)

Petrous part|

* Carotid canal
* Facial canal
* Hiatus
* Internal auditory meatus
* Cochlear aqueduct
* Stylomastoid foramen
* fossae
* Subarcuate fossa
* Jugular fossa
* canaliculi
* Inferior tympanic
* Mastoid
* Styloid process
* Petrosquamous suture
* (note: ossicles in petrous part, but not part of temporal bone)

Tympanic part|

* Suprameatal spine

Sphenoid|

| Surfaces|

* Superior surface: Sella turcica
* Dorsum sellae
* Tuberculum sellae
* Hypophysial fossa
* Posterior clinoid processes
* Ethmoidal spine
* Chiasmatic groove
* Middle clinoid process
* Petrosal process
* Clivus
* Lateral surface: Carotid groove
* Sphenoidal lingula
* Anterior surface: Sphenoidal sinuses

|

Great wings|

* foramina
* Rotundum
* Ovale
* Vesalii
* Spinosum
* Spine
* Infratemporal crest
* Sulcus of auditory tube

Small wings|

* Superior orbital fissure
* Anterior clinoid process
* Optic canal

Pterygoid
processes|

* fossae
* Pterygoid
* Scaphoid
* pterygoid plates
* Lateral
* Medial
* Pterygoid canal
* Hamulus

Other|

* Body
* Sphenoidal conchae

Ethmoid|

| Plates|

* Cribriform plate
* Crista galli
* Olfactory foramina
* Perpendicular plate

|

Surfaces|

* Lateral surface Orbital lamina
* Uncinate process
* Medial surface Supreme nasal concha
* Superior nasal concha
* Superior meatus
* Middle nasal concha
* Middle meatus

Labyrinth|

* Ethmoid sinus
* ethmoidal foramina
* Posterior
* Anterior

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* Anatomy

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