Reddy Renuka K, Reddy Rohit K, Jyung Robert W, Eloy Jean Anderson, Liu James K
Departments of 1 Neurological Surgery and.
Otolaryngology-Head & Neck Surgery, Rutgers University, New Jersey Medical School; and.
J Neurosurg. 2016 Jan;124(1):224-33. doi: 10.3171/2014.12.JNS14835. Epub 2015 Jun 26.
A century ago an ambitious young anatomist in Rome, Primo Dorello, who sought to understand the cause of abducent nerve palsy that often occurred in patients with severe middle ear infections, conducted intricate studies on the intracranial course of the nerve. In his findings, he identified that the abducent nerve passes through a narrow sinus near the apex of the petrous bone, which formed an osteofibrous canal. Dorello suggested that in this enclosed region the abducent nerve may be particularly vulnerable to compression due to the vascular edema accompanying the infection. Although his work was widely appreciated, it was not well received by all. Interestingly, Giuseppe Gradenigo, one of the most prominent Italian otologists of the early 20th century, who was known for his work on a triad of symptoms (Gradenigo's syndrome) that accompanies petrous apicitis, a result of severe middle ear infections, was obstinate in his criticism of Dorello's findings. Thus a scientific duel began, with a series of correspondence between these two academics-one who was relatively new to the otological community (Dorello) and one who was well reputed in that community (Gradenigo). The disagreement ultimately ebbed in 1909, when Dorello published a report in response to Gradenigo's criticisms and convinced Gradenigo to change his views. Today Dorello's canal is widely recognized as a key landmark in skull base surgery of the petroclival region and holds clinical significance due to its relation to the abducent nerve and surrounding vascular structures. Yet, although academics such as Dorello and Gradenigo are recognized for their work on the canal, it is important not to forget the others throughout history who have contributed to the modern-day understanding of this anatomical structure. In fact, although the level of anatomical detail found in Dorello's work was previously unmatched, the first description of the canal was made by the experienced Austrian anatomist Wenzel Leopold Gruber in 1859, almost 50 years prior to Dorello's landmark publication. Another critical figure in building the understanding of Dorello's canal was Harris Holmes Vail, a young otolaryngologist from Harvard Medical School, who in 1922 became the first person to describe Dorello's canal in the English language. Vail conducted his own detailed anatomical studies on cadavers, and his publication not only reaffirmed Dorello's findings but also immortalized the eponym used today-"Dorello's canal." In this article the authors review the life and contributions of Gruber, Dorello, Gradenigo, and Vail, four men who played a critical role in the discovery of Dorello's canal and paved the way toward the current understanding of the canal as a key clinical and surgical entity.
一个世纪前，罗马有一位雄心勃勃的年轻解剖学家普里莫·多雷洛，他试图弄清楚严重中耳感染患者常出现的展神经麻痹的病因，于是对该神经的颅内走行进行了复杂的研究。在他的研究结果中，他发现展神经穿过靠近岩骨尖的一个狭窄窦道，该窦道形成了一个骨纤维管。多雷洛认为，在这个封闭区域，展神经可能特别容易因感染伴随的血管性水肿而受到压迫。尽管他的工作广受赞誉，但并非所有人都认可。有趣的是，朱塞佩·格拉代尼戈是20世纪初最杰出的意大利耳科医生之一，他因研究严重中耳感染导致的岩尖炎所伴随的一组症状（格拉代尼戈综合征）而闻名，他却固执地批评多雷洛的研究结果。于是，一场科学对决开始了，这两位学者之间展开了一系列通信——一位在耳科学界相对新人（多雷洛），另一位在该领域声誉颇高（格拉代尼戈）。这场分歧最终在1909年平息，当时多雷洛发表了一篇回应格拉代尼戈批评的报告，并说服格拉代尼戈改变了他的观点。如今，多雷洛管被广泛认为是岩斜区颅底手术的一个关键标志，由于它与展神经及周围血管结构的关系而具有临床意义。然而，尽管像多雷洛和格拉代尼戈这样的学者因其在该管方面的工作而受到认可，但重要的是不要忘记历史上其他为当今对这一解剖结构的理解做出贡献的人。事实上，尽管多雷洛著作中的解剖细节水平此前无人能及，但该管的首次描述是由经验丰富的奥地利解剖学家文策尔·利奥波德·格鲁伯于1859年做出的，比多雷洛具有里程碑意义的出版物早了近50年。另一位对理解多雷洛管起到关键作用的人物是来自哈佛医学院的年轻耳鼻喉科医生哈里斯·霍姆斯·韦尔，他在1922年成为第一个用英语描述多雷洛管的人。韦尔对尸体进行了自己详细的解剖研究，他的出版物不仅再次证实了多雷洛的研究结果，还使如今使用的这个以人名命名的术语——“多雷洛管”得以流传。在本文中，作者回顾了格鲁伯、多雷洛、格拉代尼戈和韦尔的生平及贡献，这四人在多雷洛管的发现中发挥了关键作用，为当前将该管理解为一个关键的临床和外科实体铺平了道路。
