The enigmatic foramen lacerum

OBJECTIVE: The microanatomic details of the foramen lacerum and surrounding region are described to clarify the relationship between the internal carotid artery and the foramen lacerum. The terminology related to these structures is reevaluated. Examples of pathological abnormalities restricted to the foramen lacerum region are presented to document the clinical relevance of this region. METHODS: Microanatomic dissections were performed in 12 formalin-fixed cadaveric specimens. Bony landmarks were examined in 50 dry skulls. Microscopic sections of the region were obtained from cadaveric specimens that were formalin-fixed, decalcified, and processed for histological examination. RESULTS: The foramen lacerum is not a true foramen. No significant structures traverse its fibrocartilage. In this region, the bony and fibrous structures surround the internal carotid artery to form an incomplete canal, which serves as the rostral extension of petrous canal. CONCLUSION: The term foramen lacerum should be restricted to that portion of the cranial base at the confluence of the petrous portion of the temporal, basioccipital, and basisphenoid bones that in vivo is filled with fibrocartilage. The region immediately above the foramen lacerum, occupied by the internal carotid artery and traditionally considered the upper portion of the foramen lacerum, should be considered, anatomically and functionally, to be the rostral extension of the petrous canal. We suggest calling this extension the lacerum portion of the carotid canal.