Operative Neurosurgery

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name="wkhealth_article_publication_date" content="August 29, 2024" /><meta name="wkhealth_volume" /><meta name="wkhealth_ovid_accession_number" content="01787389-990000000-01309" /><meta name="wkhealth_issn" content="2332-4252" /><meta name="wkhealth_title" content="Application of Topographical Anatomy of the Trochlear Nerve in Transtentorial Approaches: An Anatomic Study" /><meta name="wkhealth_authors" content="Peto, Ivo;Pressman, Elliot;Piper, Keaton;Flores-Milan, Gabriel;Ryan, Casey;Vakharia, Kunal;van Loveren, Harry;Agazzi, Siviero" /><meta name="wkhealth_doi" content="10.1227/ons.0000000000001346" /><meta name="wkhealth_abstract_html_url" content="https://journals.lww.com/onsonline/abstract/9900/application_of_topographical_anatomy_of_the.1309.aspx" /><meta name="wkhealth_fulltext_html_url" content="https://journals.lww.com/onsonline/fulltext/9900/application_of_topographical_anatomy_of_the.1309.aspx" /><meta name="wkhealth_toc_section" content="Surgical Anatomy" /><meta name="wkhealth_toc_sub_section" content="Skull Base" /><meta name="wkhealth_eJpId" content="onsonline:9900:00000:01309" /><meta name="wkhealth_firstpage" content="10.1227/ons.0000000000001346" /><meta name="wkhealth_date" content="May 11, 2022" /><meta name="wkhealth_pdf_url" content="https://journals.lww.com/onsonline/_layouts/15/oaks.journals/downloadpdf.aspx?trckng_src_pg=Other&an=01787389-990000000-01309" /><meta name="Description" content="BACKGROUND AND OBJECTIVES: Transection of the free edge of tentorium (FET) might be necessary whe" /><meta property="og:site_name" content="LWW" /><meta property="og:type" content="article" /><meta property="og:title" content="Application of Topographical Anatomy of the Trochlear Nerve ... : Operative Neurosurgery" /><meta property="og:description" content="investigated the relationship of the trochlear and oculomotor nerve and FET in an attempt to identify a safe zone for such maneuver. METHODS: Ten embalmed specimens (20 sides) were studied and the following morphometric measurements were taken using digital microcalipers: trochlear (TP) to oculomotor porus (OP), length of the intratentorial segment of cranial nerve (CN) IV, nerve free FET, and distance along the oculomotor (CN III) from its OP to CN III/trochlear (CN IV) crossing and angle between the long-axis petrous ridge and TP (petrotrochlear angle). RESULTS: The CN IV pierced the deep layer of the FET in all cases at a mean distance 8.11 mm (4.43-11.33) posterior to the OP, measured along the FET. CN IV continued within the tentorial edge for a mean of 6.17 mm (3.18-11.33) before entering the cavernous sinus at a mean distance of 1.9 mm (0-5.46 mm) from the posterior-most aspect of the OP. A nerve-free portion of FET was 1.93 mm (mean) (0-5.46). No nerve-free FET segment (<1 mm) was observed in 4 sides (20%), and a nerve-free FET segment <2.00 mm was seen in 55% of cases. The mean distance from OP to the CN III/IV crossing was 10.17 mm (1.00-15.57). The mean petrotrochlear angle was 164.49掳 (140.01-183.85), and >175掳 in 4 specimens (20%). CONCLUSION: Our data confirm presence of the intratentorial segment of CN IV. Transection of the FET carries the lowest risk of CN IV injury if performed < 2 mm or >10 mm posterior to the OP, or posterior to intersection of the FET and a virtual extension of a petrous ridge...." /><meta property="og:image" content="https://images.journals.lww.com/onsonline/SocialThumb.01787389-990000000-01309.F1.jpeg" /><meta property="og:image:width" content="598" /><meta property="og:image:height" content="496" /><meta property="og:url" content="https://journals.lww.com/onsonline/fulltext/9900/application_of_topographical_anatomy_of_the.1309.aspx" /><meta property="twitter:card" content="summary" /><meta name="robots" content="index, follow, noarchive" /><meta name="WT.sv" content="ZUSE1PEJPWEB02" /><meta name="Title" content="Operative Neurosurgery" /><style id="SPThemeHideForms" type="text/css">body {opacity:0 !important}</style>  <link href="https://fonts.googleapis.com/css?family=Arvo:400,400i,700|Fira+Sans:300,300i,400,400i,500,500i,600,600i,700,700i&display=swap" 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View from medial to posterior-lateral. Superficial layer of the FET/temporal lobe dura (black asterisk) was cut at the entrance of the CN IV into the CS. The trochlear nerve enters at the posterior apex of oculomotor triangle and pierces the deep layer of the FET and enters the FET through the trochlear porus (black arrow). I courses anteriorly in its tentorial segment (green line) embedded in between both layers of the FET, before it exits the FET and enters the CS (white arrowhead). It runs parallel to the CN III until it crosses over the CN III (black arrowhead). The distance along the white double arrow denotes the nerve-free segment of the FET. The double arrow along the CN III denotes the distance of CN III/CN IV decussation measured along the CN III from the oculomotor porus (curved arrow). White asterisk鈥攑osterior petroclinoid fold. Numerous anatomic structures have been omitted for clarity (eg, CNs V, VI, and posterior communicating artery). CN, cranial nerve; CS, cavernous sinus; CN III, oculomotor, CN IV, trochlear; FET, free edge of tentorium.","https://images.journals.lww.com/onsonline/Rollover.01787389-990000000-01309.F1.jpeg","https://images.journals.lww.com/onsonline/Gallery.01787389-990000000-01309.F1.jpeg","https://journals.lww.com/onsonline/_layouts/oaks.journals/ImageView.aspx?k=onsonline:9900:00000:01309&i=F1&year=9900&issue=00000&article=01309&type=Abstract","https://images.journals.lww.com/onsonline/Original.01787389-990000000-01309.F1.jpeg","/onsonline/pages/imagegallery.aspx?year=9900&issue=00000&article=01309", "onsonline_9900_00000_01309_F1");images["F2"]=new image("F2","F3","F1","FIGURE 2.","<strong xmlns:mrws=\"http://webservices.ovid.com/mrws/1.0\">A</strong>, Left-sided view of the free tentorial edge splitting into aPCF (thin arrows) and pPCF (white arrowhead), creating oculomotor triangle (*). Note the entry of CN III into the apex of the oculomotor triangle. <strong xmlns:mrws=\"http://webservices.ovid.com/mrws/1.0\">B</strong>, Left-sided view of the free tentorial edge and trochlear porus (thin arrows). Note the entry of CN III into the apex of the oculomotor triangle (*). aPCF, anterior petroclinoid fold; CN, cranial nerve; CN III, oculomotor nerve; CN IV, trochlear nerve; pPCF, posterior petroclinoid fold; black arrow鈥攃isternal segment of CN IV.","https://images.journals.lww.com/onsonline/Rollover.01787389-990000000-01309.F2.jpeg","https://images.journals.lww.com/onsonline/Gallery.01787389-990000000-01309.F2.jpeg","https://journals.lww.com/onsonline/_layouts/oaks.journals/ImageView.aspx?k=onsonline:9900:00000:01309&i=F2&year=9900&issue=00000&article=01309&type=Abstract","https://images.journals.lww.com/onsonline/Original.01787389-990000000-01309.F2.jpeg","/onsonline/pages/imagegallery.aspx?year=9900&issue=00000&article=01309", "onsonline_9900_00000_01309_F2");images["F3"]=new image("F3","F4","F2","FIGURE 3.","<strong xmlns:mrws=\"http://webservices.ovid.com/mrws/1.0\">A</strong>, Left-sided view of the free tentorial edge at the aPCF segment and trochlear porus. The aPCF has been reflected medially and the deep (thin arrow) and superficial layer (thick arrow) split, demonstrating the course of CN IV in the FET. <strong xmlns:mrws=\"http://webservices.ovid.com/mrws/1.0\">B</strong>, Left-sided view of aPCF segment and the tentorial segment of CN IV. The aPCF has been reflected 180\u00B0 medially and the deep (thin arrow) and superficial layer (thick arrow) split, demonstrating the course of CN IV in the FET and its entrance into the cavernous sinus (arrowhead). aPCF, anterior petroclinoid fold; CN, cranial nerve; CN III, oculomotor nerve; CN IV, trochlear nerve; FET, free edge of tentorium.","https://images.journals.lww.com/onsonline/Rollover.01787389-990000000-01309.F3.jpeg","https://images.journals.lww.com/onsonline/Gallery.01787389-990000000-01309.F3.jpeg","https://journals.lww.com/onsonline/_layouts/oaks.journals/ImageView.aspx?k=onsonline:9900:00000:01309&i=F3&year=9900&issue=00000&article=01309&type=Abstract","https://images.journals.lww.com/onsonline/Original.01787389-990000000-01309.F3.jpeg","/onsonline/pages/imagegallery.aspx?year=9900&issue=00000&article=01309", "onsonline_9900_00000_01309_F3");images["F4"]=new image("F4","F5","F3","FIGURE 4.","Left-sided view of the tentorial and cavernous segment of CN IV. The arrowhead demarcates arcuate ligamentous fibers constituting the anterior limit of tentorial segment of CN IV. CN, cranial nerve; CN IV, trochlear nerve.","https://images.journals.lww.com/onsonline/Rollover.01787389-990000000-01309.F4.jpeg","https://images.journals.lww.com/onsonline/Gallery.01787389-990000000-01309.F4.jpeg","https://journals.lww.com/onsonline/_layouts/oaks.journals/ImageView.aspx?k=onsonline:9900:00000:01309&i=F4&year=9900&issue=00000&article=01309&type=Abstract","https://images.journals.lww.com/onsonline/Original.01787389-990000000-01309.F4.jpeg","/onsonline/pages/imagegallery.aspx?year=9900&issue=00000&article=01309", "onsonline_9900_00000_01309_F4");images["F5"]=new image("F5","F6","F4","FIGURE 5.","<strong xmlns:mrws=\"http://webservices.ovid.com/mrws/1.0\">A</strong>, Left-sided view of deep layer of aPCF and the tentorial segment of CN IV (green) and cavernous segment (blue). The superficial layer of aPCF has been removed. Red line denotes the nerve-free segment of FET. <strong xmlns:mrws=\"http://webservices.ovid.com/mrws/1.0\">B</strong>, Left-sided view of the tentorial segment of CN IV. The arrowhead demarcates the trochlear porus. Asterisk demarcates the transition to the CS segment and attachment. <strong xmlns:mrws=\"http://webservices.ovid.com/mrws/1.0\">C</strong>, Intraoperative photograph of the right tentorial edge showing the deep layer of the FET and aPCF (asterisk), while the superficial layer has been peeled away and resected. Arrow鈥擟N III entering the CS underneath the deep layer of aPCF. Dashed area is magnified on the right. Thin arrows depict course of the CN IV in the FET and its proximal segment as it enters the CS. aPCF, anterior petroclinoid fold; CN, cranial nerve; CN III, oculomotor nerve; CN IV, trochlear nerve; FET, free edge of tentorium; CS, cavernous sinus.","https://images.journals.lww.com/onsonline/Rollover.01787389-990000000-01309.F5.jpeg","https://images.journals.lww.com/onsonline/Gallery.01787389-990000000-01309.F5.jpeg","https://journals.lww.com/onsonline/_layouts/oaks.journals/ImageView.aspx?k=onsonline:9900:00000:01309&i=F5&year=9900&issue=00000&article=01309&type=Abstract","https://images.journals.lww.com/onsonline/Original.01787389-990000000-01309.F5.jpeg","/onsonline/pages/imagegallery.aspx?year=9900&issue=00000&article=01309", "onsonline_9900_00000_01309_F5");images["F6"]=new image("F6","F7","F5","FIGURE 6.","Artist\'s illustration of the relationship between the petrous ridge and the trochlear porus pertinent to posterior fossa approaches. Note that the trochlear porus (arrow) is located anterior to the intersection of the free edge of tentorium (purple line) and a virtual extension of the petrous ridge (blue line).","https://images.journals.lww.com/onsonline/Rollover.01787389-990000000-01309.F6.jpeg","https://images.journals.lww.com/onsonline/Gallery.01787389-990000000-01309.F6.jpeg","https://journals.lww.com/onsonline/_layouts/oaks.journals/ImageView.aspx?k=onsonline:9900:00000:01309&i=F6&year=9900&issue=00000&article=01309&type=Abstract","https://images.journals.lww.com/onsonline/Original.01787389-990000000-01309.F6.jpeg","/onsonline/pages/imagegallery.aspx?year=9900&issue=00000&article=01309", "onsonline_9900_00000_01309_F6");images["F7"]=new image("F7","","F6","FIGURE 7.","<strong xmlns:mrws=\"http://webservices.ovid.com/mrws/1.0\">A</strong>, Intraoperative photograph of the CN IV as viewed from right retrosigmoid approach and transectioning of the free edge of tentorium (asterisk) at the lateral incisural space. The cisternal segment of CN IV is in view. <strong xmlns:mrws=\"http://webservices.ovid.com/mrws/1.0\">B</strong>, Tentorial edge has been depressed inferiorly to gain wider view of the CN IV. Trochlear porus is still not visible anteriorly and a safe transection is performed. CN, cranial nerve; CN IV, trochlear nerve.","https://images.journals.lww.com/onsonline/Rollover.01787389-990000000-01309.F7.jpeg","https://images.journals.lww.com/onsonline/Gallery.01787389-990000000-01309.F7.jpeg","https://journals.lww.com/onsonline/_layouts/oaks.journals/ImageView.aspx?k=onsonline:9900:00000:01309&i=F7&year=9900&issue=00000&article=01309&type=Abstract","https://images.journals.lww.com/onsonline/Original.01787389-990000000-01309.F7.jpeg","/onsonline/pages/imagegallery.aspx?year=9900&issue=00000&article=01309", "onsonline_9900_00000_01309_F7"); return images; }function getPopupImageId() { return $get("ctl00_ctl29_g_9d8d8345_79ae_4158_b5f4_0e00a33d4d27_ctl00_slideShowUserControl_popupImageId"); }function getIsExportToPPT() { return $get("ctl00_ctl29_g_9d8d8345_79ae_4158_b5f4_0e00a33d4d27_ctl00_slideShowUserControl_IsExportToPPT"); }//]]> </script> <script src="/ScriptResource.axd?d=11ySqNT2t8wJXf-5ynqkHTYVaR0CZPUQDLhFk5-B61-yY4pHK9T4A-OmNoLERHX1OU2F3io32lKHXeNlvH0kpnJP6-ZQm2Ado5OlvNqUwB9TpwuIgMVQBgIz-DSVpHWqDoVFHrt69C9fSrbhF6t9QBuuAcSpa-p9_2de4EnR0aU1&t=2265eaa7" type="text/javascript"></script> <script src="/_layouts/15/blank.js?rev=DkvtcIrq8iOu%2FY%2Ff2C9qhQ%3D%3DTAG0" type="text/javascript"></script> <script type="text/javascript"> //<![CDATA[ window.SPThemeUtils && SPThemeUtils.RegisterCssReferences([]); 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or-spacing"><span>or</span></li> <li id="ctl00_ctl51_Header_UserActionTools_liRegister2" class="user-menu__item dib"> <a id="ctl00_ctl51_Header_UserActionTools_RegisterUserPopupLnk" class="user-menu__link js-register-link" data-config="{"eventName":"Register","eventDetail":{"source":"Masthead Dropdown"},"isNull":false}" href="https://journals.lww.com/onsonline/pages/register.aspx?ContextUrl=%2fonsonline%2fabstract%2f9900%2fapplication_of_topographical_anatomy_of_the.1309.aspx">Register</a> </li> <li id="ctl00_ctl51_Header_UserActionTools_liSubscribe" role="presentation" class="user-menu__item dib"> <a id="ctl00_ctl51_Header_UserActionTools_lnkSubscribe" class="user-menu__link" href="https://shop.lww.com/p/2332-4252" target="_blank"><i class="fa fa-bars"></i> <span class="hideOnFixed">Subscribe to journal</span><span class="showOnFixed">Subscribe</span></a> </li> <li id="ctl00_ctl51_Header_UserActionTools_liIssueAlerts" class="user-menu__item dib"> <i class="fa fa-envelope"></i> <a rel="nofollow" title href="javascript:javascript: alerts_ShowSubscribeeTOCPopup('Operative Neurosurgery','onsonline','eTOC', 'eTOC');;" onclick="javascript: alerts_ShowSubscribeeTOCPopup('Operative Neurosurgery','onsonline','eTOC', 'eTOC');" class="user-menu__link"><span id="ctl00_ctl51_Header_UserActionTools_SubscribeToAlertsActionToolLink_defaultText" class="hideOnFixed">Get new issue alerts</span><span id="ctl00_ctl51_Header_UserActionTools_SubscribeToAlertsActionToolLink_stickyText" class="showOnFixed">Get alerts</span></a> </li> </ul> </section> <span id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_dummyTargetControl"></span> <div id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_pnlunSubscribeToAlerts" style="display: none;"> <div tabindex="-1" role="dialog" class="wk-modal horizontally-centered small wk-modal-with-overlay wk-modal-small ejp-modal"> <div id="ej-box-modal-style-1"> <div id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_pnlMain"> <div id="tocUnsubscribeModal" > <section class="wk-modal-content"> <header class="wk-modal-header ejp-modal-header"> <div class="wk-modal-title ejp-modal-title"></div> <button aria-label="close dialog" class="js-close primary-button wk-button-icon wk-modal-close ejp-modal-close "><i class="fa fa-times"></i></button> </header> <div class="wk-modal-body"> <div class="wk-field-item"> <p> <span id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_lblUnsubscribeMessage"></span> </p> <div class="wk-button-bar"> <div class="wk-button-group-left"> <p id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_pUnsubscribeButtons" Style="display: none;"> <input type="submit" name="ctl00$ctl51$Header$UserActionTools$ucUnsubscribeToAlertsUserControl$btnContinue" value="Yes" onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl00$ctl51$Header$UserActionTools$ucUnsubscribeToAlertsUserControl$btnContinue", "", true, "", "", false, false))" id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_btnContinue" class="primary-button" /> <input type="button" value="No" id="btnCancel" aria-label="close dialog" class="js-close secondary-button" /> </p> </div> </div> </div> </div> </section> </div> </div> </div> </div> </div> <div id="ej-clear-float"> </div> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$ucUnsubscribeToAlertsUserControl$hiddenUnSubscribeAlertType" id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnSubscribeAlertType" /> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$ucUnsubscribeToAlertsUserControl$hiddenUnsubscribeJournalId" id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnsubscribeJournalId" /> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$ucUnsubscribeToAlertsUserControl$hiddenUnsubscribeMessage" id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnsubscribeMessage" /> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$ucUnsubscribeToAlertsUserControl$hiddenTopicalCollectionId" id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenTopicalCollectionId" /> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$ucUnsubscribeToAlertsUserControl$hiddenOvidId" id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenOvidId" /> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$ucUnsubscribeToAlertsUserControl$hiddenJournalId" id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenJournalId" /> <script type="text/javascript"> function alerts_ShowUnSubscribeeTOCPopup(title, alertType, journalId) { var unSubscribeeTocPopup = $find('unSubscribeToAlerts'); var lblUnsubscribeMessage = document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_lblUnsubscribeMessage'); lblUnsubscribeMessage.innerHTML = title; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnSubscribeAlertType').value = alertType; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnsubscribeMessage').value = title; $('#' + 'ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_pUnsubscribeButtons').show(); if (document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenJournalId').value == null || document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenJournalId').value == '') { document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenJournalId').value = journalId; } if (unSubscribeeTocPopup != null) { unSubscribeeTocPopup.show(); } } function alerts_ShowUnSubscribeeTOCPopup_Root(title, journalId, alertType) { var unSubscribeeTocPopup = $find('unSubscribeToAlerts'); var lblUnsubscribeMessage = document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_lblUnsubscribeMessage'); lblUnsubscribeMessage.innerHTML = title; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnsubscribeMessage').value = title; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnSubscribeAlertType').value = alertType; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnsubscribeJournalId').value = journalId; $('#' + 'ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_pUnsubscribeButtons').show(); if (unSubscribeeTocPopup != null) { unSubscribeeTocPopup.show(); } } function alerts_ShowUnSubscribeeTOCPopup_Citation(title, journalId, ovidId) { var unSubscribeeTocPopup = $find('unSubscribeToAlerts'); var lblUnsubscribeMessage = document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_lblUnsubscribeMessage'); lblUnsubscribeMessage.innerHTML = title; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnsubscribeMessage').value = title; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnSubscribeAlertType').value = 'Citation'; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnsubscribeJournalId').value = journalId; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenOvidId').value = ovidId; $('#' + 'ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_pUnsubscribeButtons').show(); if (unSubscribeeTocPopup != null) { unSubscribeeTocPopup.show(); } } function alerts_ShowUnSubscribeeTOCPopup_Topical(title, journalId, topicalCollectionId) { var unSubscribeeTocPopup = $find('unSubscribeToAlerts'); var lblUnsubscribeMessage = document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_lblUnsubscribeMessage'); lblUnsubscribeMessage.innerHTML = title; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnsubscribeMessage').value = title; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnSubscribeAlertType').value = 'Topical'; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnsubscribeJournalId').value = journalId; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenTopicalCollectionId').value = topicalCollectionId; $('#' + 'ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_pUnsubscribeButtons').show(); if (document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenJournalId').value == null || document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenJournalId').value == '') { document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenJournalId').value = journalId; } if (unSubscribeeTocPopup != null) { unSubscribeeTocPopup.show(); } } function alerts_ShowUnSubscribeeTOCSuccessPopup() { var unSubscribeeTocPopup = $find('unSubscribeToAlerts'); if (unSubscribeeTocPopup != null) { unSubscribeeTocPopup.show(); } } $('.js-close').on('click', function() { var unSubscribeeTocPopup = $find('unSubscribeToAlerts'); if (unSubscribeeTocPopup != null) { unSubscribeeTocPopup.hide(); } return false; }); </script> <span id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_dummyTargetControl"></span> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$SubscribeToEtocPopupControl$hiddenSubscribeToEtocPopupState" id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenSubscribeToEtocPopupState" value="showemail" /> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$SubscribeToEtocPopupControl$hiddenConfirmSubscriptionPageUrl" id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenConfirmSubscriptionPageUrl" /> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$SubscribeToEtocPopupControl$hiddenJournalId" id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenJournalId" /> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$SubscribeToEtocPopupControl$hiddenSubscriptionType" id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenSubscriptionType" /> <div id="divPopupOverLay" class="Popup-Overlay" style="display: none; position: fixed; left: 0; top: 0; z-index: 3800; width: 1920px; height: 4517px;"></div> <div id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_pnlSubscribeToEtoc" class="etoc-popup ej-box-modal-drop-shadow" style="display: none;"> <div tabindex="-1" role="dialog" class="wk-modal horizontally-centered small wk-modal-with-overlay wk-modal-small ejp-modal"> <div id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_pnlMain" onkeypress="javascript:return WebForm_FireDefaultButton(event, 'ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_btnContinue')"> <section class="wk-modal-content"> <header class="wk-modal-header ejp-modal-header"> <div class="wk-modal-title ejp-modal-title"> <span id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_lblTitle"></span> </div> <button aria-label="close dialog" class="js-close primary-button wk-button-icon wk-modal-close ejp-modal-close "> <i class="fa fa-times"></i> </button> </header> <div class="wk-modal-body"> <div class="wk-field-item"> <div class="wk-field-body"> <strong> <span id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_lblThankYouMessage"></span></strong> </div> <div class="wk-field-body"> <span id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_cvEmailError" style="color:Black;display:none;"> <div class="ej-error-message"> <p class="ej-error-message-icon error-red"> </p> </div> </span> <label for="Email input">Enter your Email address:</label> <div class="wk-field-body"> <input name="ctl00$ctl51$Header$UserActionTools$SubscribeToEtocPopupControl$txtEmailAddress" type="text" id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_txtEmailAddress" class="ej-box-modal-style-1-input" /> </div> </div> <div class="wk-button-bar"> <div class="wk-button-group-left"> <input type="submit" name="ctl00$ctl51$Header$UserActionTools$SubscribeToEtocPopupControl$btnContinue" value="Continue" onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl00$ctl51$Header$UserActionTools$SubscribeToEtocPopupControl$btnContinue", "", true, "", "", false, false))" id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_btnContinue" class="primary-button" /> <input type="button" value="Cancel" id="btnCancel" class="js-close secondary-button" /> </div> </div> </div> <div class="wk-field-item"> <div class="wk-field-body"> <a id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hypPrivacy" href="https://journals.lww.com/onsonline/_layouts/oaks.journals/privacy.aspx" target="_blank">Privacy Policy</a> </div> </div> </div> </section> </div> <div id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_pnlAuthenticatedUser" style="display: none;"> <section class="wk-modal-content"> <header class="wk-modal-header ejp-modal-header"> <div class="wk-modal-title ejp-modal-title"></div> <button aria-label="close dialog" class="js-close primary-button wk-button-icon wk-modal-close ejp-modal-close "><i class="fa fa-times"></i></button> </header> <div class="wk-modal-body"> <div class="wk-field-item"> <p> <strong> <span id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_lblAuthenticatedUserTitle"></span> </strong> </p> </div> <p id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_pAuthenticatedUserMessage"> </p> </div> </section> </div> </div> </div> <div id="ej-clear-float"> </div> <script type="text/javascript"> function alerts_SaveSubscriptionTypeInHiddenField(url, subscriptionType, journalId, yearId, issueId, articleId) { if (journalId && yearId && issueId && articleId) { logCounterDataAlertWhenCitedSynchronously(journalId, yearId, issueId, articleId); } $('#' + 'ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenSubscriptionType').val(subscriptionType); $('#' + 'ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenJournalId').val(journalId); if (url) window.location = url; else __doPostBack('hypSubscribeToAlerts'); return false; } function alerts_ShowSubscribeeTOCPopup(journalTitle, journalId, subscriptionType, displaySubscriptionType) { $('#' + 'ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenSubscriptionType').val(subscriptionType); var subscribeToEtocPopup = $find('subscribeToEtoc'); subscribeToEtocPopup.show(); document.getElementsByTagName( 'html' )[0].classList.add('no-scroll'); var modelPopupState = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenSubscribeToEtocPopupState'); var emailTextBox = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_txtEmailAddress'); var thanksPanel = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_pnlAuthenticatedUser'); var mainPanel = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_pnlMain'); var thankYouMessageUnAuthenticated = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_lblThankYouMessage'); var thankYouMessageAuthenticated = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_lblAuthenticatedUserTitle'); if (!displaySubscriptionType) { displaySubscriptionType = subscriptionType; } if (modelPopupState.value == 'showthanksmessage') { thanksPanel.style.display = "block"; mainPanel.style.display = "none"; thankYouMessageAuthenticated.innerHTML = "Thank you for subscribing to the " + displaySubscriptionType + " for " + journalTitle + "."; } if (modelPopupState.value == 'showemail') { thanksPanel.style.display = "none"; mainPanel.style.display = "block"; thankYouMessageUnAuthenticated.innerHTML = "Thank you for choosing to subscribe to the " + displaySubscriptionType + " for " + journalTitle + "."; } if ($('.etoc-popup') != null) { document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenJournalId').value = journalId; if (modelPopupState.value == 'showemail') emailTextBox.focus(); } } $('.js-close').on('click', function () { document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_txtEmailAddress').value = ""; document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_cvEmailError').style.display = "none"; var pageUrl = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenConfirmSubscriptionPageUrl'); var subscribeeTocPopup = $find('subscribeToEtoc'); if (subscribeeTocPopup != null) { subscribeeTocPopup.hide(); document.getElementsByTagName( 'html' )[0].classList.remove('no-scroll'); if (pageUrl.value !== '' && pageUrl.value !== window.location.pathname) window.location = pageUrl.value; } return false; }); </script> <div id="ctl00_ctl51_Header_UserActionTools_eTocTopContainer"> <div id="eTocTop" style="display: none;"> <a rel="nofollow" title href="javascript:javascript: alerts_ShowSubscribeeTOCPopup('Operative Neurosurgery','onsonline','eTOC', 'eTOC');;" onclick="javascript: alerts_ShowSubscribeeTOCPopup('Operative Neurosurgery','onsonline','eTOC', 'eTOC');"><span id="ctl00_ctl51_Header_UserActionTools_alertLinkControlTop_defaultText" class="hideOnFixed">Subscribe to eTOC</span></a> </div> </div> <script> $(function () { //find recent searches link and move container var recentSearchesControl = $("a[id$='RecentSearches']"); if (recentSearchesControl.length) { recentSearchesControl.click(function (e) { e.stopPropagation(); if ($("#ResentSearchContainer").is(":hidden")) { $("#ResentSearchContainer").slideDown("slow"); recentSearchesControl.addClass('open'); } else { $("#ResentSearchContainer").hide(); recentSearchesControl.removeClass('open'); } }); } var eTocAccountLink = $("ul.js-user-action-toolbar__dropdown>li>a[id='SubscribeToEToc']"); if (eTocAccountLink.length) { eTocAccountLink.parent().html($("#eTocTop>a")); } }); </script> <a class="logo-secondary white" href="http://wolterskluwer.com/" target="_blank"> <h3 class="logo-secondary-text">Secondary Logo</h3> </a> <a href="#" class="sticky-search"><i class="fa fa-search"></i></a> </div> <div class="header__layout-bottom wk-grid-page-container"> <a id="hypJournals" class="logo-main" href="https://journals.lww.com/onsonline/pages/default.aspx"> <h3 class="logo-main-text">Journal Logo </h3> </a> <div class="search-v2"> <div class="search-wrapper"> <select name="ctl00$ctl51$Header$SearchTopBoxControl$ddlContentScope" id="ctl00_ctl51_Header_SearchTopBoxControl_ddlContentScope"> <option value="All">All</option> <option selected="selected" value="Articles">Articles</option> <option value="Images">Images</option> <option value="Videos">Videos</option> <option value="Podcasts">Podcasts</option> <option value="Blogs">Blogs</option> </select> <div class="input-group" id="globalSearch"> <input name="ctl00$ctl51$Header$SearchTopBoxControl$txtKeywords" type="text" value="Search" id="ctl00_ctl51_Header_SearchTopBoxControl_txtKeywords" class="form-control searchText" /> <span class="input-group-btn"> <button id="ctl00_ctl51_Header_SearchTopBoxControl_btnGlobalSearchMagnifier" type="submit" class="btn btn-default"><i class="fa fa-search"></i></button> </span> <input type="hidden" name="ctl00$ctl51$Header$SearchTopBoxControl$IsAutoCompleteEnabled" id="ctl00_ctl51_Header_SearchTopBoxControl_IsAutoCompleteEnabled" value="false" /> <input type="hidden" name="ctl00$ctl51$Header$SearchTopBoxControl$AutocompleteApiUrl" id="ctl00_ctl51_Header_SearchTopBoxControl_AutocompleteApiUrl" value="https://platformservices.wolterskluwerhealth.com/autocomplete/oneus/shingle/" /> </div> </div> <div class="advance-search" style=""> <a id="ctl00_ctl51_Header_SearchTopBoxControl_lnkAdvanceSearch" href="https://journals.lww.com/onsonline/pages/advancedsearch.aspx">Advanced Search</a> <input type="submit" name="ctl00$ctl51$Header$SearchTopBoxControl$btnGlobalSearch" value="" id="ctl00_ctl51_Header_SearchTopBoxControl_btnGlobalSearch" disabled="disabled" class="aspNetDisabled btnGlobalSearch" style="display: none;" /> <input name="ctl00$ctl51$Header$SearchTopBoxControl$hfldKeywords" type="hidden" id="ctl00_ctl51_Header_SearchTopBoxControl_hfldKeywords" class="hfldKeywords" value="disableButton" /> </div> </div> <script> $(function() { try { var objSearchBox = { btnGlobalSearchMagnifierId: 'ctl00_ctl51_Header_SearchTopBoxControl_btnGlobalSearchMagnifier', searchButtonId: 'ctl00_ctl51_Header_SearchTopBoxControl_btnGlobalSearch', txtKeywordsId: 'ctl00_ctl51_Header_SearchTopBoxControl_txtKeywords', hfldKeywordsHiddenId: 'ctl00_ctl51_Header_SearchTopBoxControl_hfldKeywords', defaultSearchText: 'Search' }; new Searchbox(objSearchBox).Init(); } catch (e) { console.error(e); } }); //autocomplete functionality for basic search //this functionality will call the SBA url and start suggesting after typing 3rd character var textKeywords = null; var hiddenAutocompleteApiUrl = null; var buttonGlobalSearch = null; $(function () { try { var objAutocomplete = { hiddenIsAutoCompleteEnabled: $('#ctl00_ctl51_Header_SearchTopBoxControl_IsAutoCompleteEnabled'), textKeywords: $('#ctl00_ctl51_Header_SearchTopBoxControl_txtKeywords'), hiddenAutocompleteApiUrl: $('#ctl00_ctl51_Header_SearchTopBoxControl_AutocompleteApiUrl'), buttonGlobalSearch: $('#ctl00_ctl51_Header_SearchTopBoxControl_btnGlobalSearch'), enableNewAutoComplete: true, newAutoCompleteUrl: 'https://dxg-search-na-prd.wkgposvc.cloud/Query.svc/Query_Expand', newAutoCompleteMaxSuggestions: '10', newAutoCompleteDictionaryIds: 'ovid_sted28_mesh22' }; autoComplete(objAutocomplete); } catch (e) { console.error(e); } }); $(function () { let searchSelect = $('select[id$="ddlContentScope"]');; if (searchSelect.length){ searchSelect.selectize(); } }); </script> </div> <div id="main-nav-container-v2"> <nav 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'Application of Topographical Anatomy of the Trochlear Nerve in Transtentorial Approaches: An Anatomic Study', '08292024', 'Ivo Peto, Elliot Pressman, Keaton Piper, et al', '', '', '\u00A9 Congress of Neurological Surgeons 2024. All rights reserved.', '01787389-990000000-01309', '', false, ''); } </script> <div id="ArticleContainer"> <article id="ej-abstract-view" xmlns:ssr="http://ssr-eus-go-csi.cloudapp.net/v1/assets" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xhtml="http://www.w3.org/1999/xhtml"><section class="ejp-r-article-subsection"><div class="ejp-r-article-subsection__text">Surgical Anatomy: Skull Base</div></section><header class="ejp-article-header"><h1 class="ejp-article-title">Application of Topographical Anatomy of the Trochlear Nerve in Transtentorial Approaches: An Anatomic Study</h1></header><section id="ejp-article-authors"><p id="P7"><i class="wki icon-orcid" onclick="javascript:ToolTip_Orcid('Peto, Ivo MD', 'https://orcid.org/0000-0002-6015-6862');" onmouseover="javascript:ToolTip_Orcid('Peto, Ivo MD', 'https://orcid.org/0000-0002-6015-6862');"></i>Peto, Ivo MD; Pressman, Elliot MD; Piper, Keaton MD; Flores-Milan, Gabriel MD; Ryan, Casey MD; Vakharia, Kunal MD; van Loveren, Harry MD; Agazzi, Siviero MD</p><section><a href="#" id="ejp-article-authors-link"> Author Information <i class="wk-icon-arrow-down-r"></i></a></section></section><section id="ejp-article-authors-info" class="ejp-article-authors-info ejp-article-authors-info--hidden"><div class="ejp-article-authors-info-holder"> <p id="">Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, USA</p> <p id="cor1"><strong xmlns:mrws="http://webservices.ovid.com/mrws/1.0">Correspondence:</strong> Siviero Agazzi, MD, Department of Neurosurgery and Brain Repair, University of South Florida, 2 Tampa General Circle, Tampa, FL33606, USA. Email: <span><a href="/cdn-cgi/l/email-protection#39545850554d56034a585e58434350794c4a5f175c5d4c" onclick="javascript:window.open('mailto:mailto:sagazzi@usf.edu');return false"><span class="__cf_email__" data-cfemail="a2d1c3c5c3d8d8cbe2d7d1c48cc7c6d7">[email protected]</span></a></span></p> </div></section><section id="article-journal-info"><div class="ej-journal-info"><span class="ej-journal-name">Operative Neurosurgery </span><span id="ej-journal-date-volume-issue-pg">():10.1227/ons.0000000000001346, August 29, 2024.</span><span> | </span><span class="ej-journal-doi">DOI: </span>10.1227/ons.0000000000001346</div></section><section id="ejp-article-indicators" class="ejp-article-indicators"><ul class="ejp-article-indicators__list"> <li id="ej-article-indicators-buy" class="ejp-article-indicators__list-item" onmouseover="javascript:Tooltip_Buy()" onmouseout="javascript:Tooltip_MouseOut()"><a href="#ContentAccessOptions"><span class="ejp-indicator">Buy</span></a></li> <li id="ej-article-indicators-pap" class="ejp-article-indicators__list-item" onmouseover="javascript:Tooltip_PAP('Published Ahead-of-Print', 'This article has not yet been published in final form.')" onmouseout="javascript:Tooltip_MouseOut()"><span class="ejp-indicator">PAP</span></li> </ul><button id="openArticleMetricsPopupButton" type="button" class="wk-button wk-button-ghost wk-button-icon-left ejp-article-metrics-btn" data-articleMetricsEndpoint="//services.journals.lww.com/IntegrationServices/ArticleMetricsService.svc" data-articleMetricsDetailsUrl="https://wolterskluwer.altmetric.com/details/" data-doi="10.1227/ons.0000000000001346" data-suiteId="vrs_woltere_journalsglobalvrs" data-articlePublicationDate="2024-08-29" data-articlePublicationDateString="August 29, 2024" data-receivedDate="2024-04-30" data-revisionReceivedDate="" data-acceptedDate="2024-07-15" data-crossrefRefLinkRoot="https://doi.org/" data-medlineRefLinkRoot="http://www.ncbi.nlm.nih.gov/pubmed/" data-pubMedId="39207147"><i class="wk-icon-filled-chart-r"></i><i class="wk-icon-filled-chart-white-r"></i> Metrics </button></section><section class="ejp-article-tabs" id="abstractWrap"><h2 class="ejp-article-tabs-heading">Abstract</h2> <div class="ejp-article-tabs__tabpanel" id="panel1" role="tabpanel" aria-labelledby="tab1"> <div id="article-abstract-content1"> <div class="ejp-article-text-abstract"> <h3>BACKGROUND AND OBJECTIVES: </h3> <p>Transection of the free edge of tentorium (FET) might be necessary when approaching cavernous sinus lesions, clip placement in certain posterior communicating artery aneurysms, or during transpetrosal and retrosigmoid transtentorial approaches. No anatomic study has investigated the relationship of the trochlear and oculomotor nerve and FET in an attempt to identify a safe zone for such maneuver.</p> <h3>METHODS: </h3> <p>Ten embalmed specimens (20 sides) were studied and the following morphometric measurements were taken using digital microcalipers: trochlear (TP) to oculomotor porus (OP), length of the intratentorial segment of cranial nerve (CN) IV, nerve free FET, and distance along the oculomotor (CN III) from its OP to CN III/trochlear (CN IV) crossing and angle between the long-axis petrous ridge and TP (petrotrochlear angle).</p> <h3>RESULTS: </h3> <p>The CN IV pierced the deep layer of the FET in all cases at a mean distance 8.11 mm (4.43-11.33) posterior to the OP, measured along the FET. CN IV continued within the tentorial edge for a mean of 6.17 mm (3.18-11.33) before entering the cavernous sinus at a mean distance of 1.9 mm (0-5.46 mm) from the posterior-most aspect of the OP. A nerve-free portion of FET was 1.93 mm (mean) (0-5.46). No nerve-free FET segment (<1 mm) was observed in 4 sides (20%), and a nerve-free FET segment <2.00 mm was seen in 55% of cases. The mean distance from OP to the CN III/IV crossing was 10.17 mm (1.00-15.57). The mean petrotrochlear angle was 164.49掳 (140.01-183.85), and >175掳 in 4 specimens (20%).</p> <h3>CONCLUSION: </h3> <p>Our data confirm presence of the intratentorial segment of CN IV. Transection of the FET carries the lowest risk of CN IV injury if performed < 2 mm or >10 mm posterior to the OP, or posterior to intersection of the FET and a virtual extension of a petrous ridge.</p> </div> </div> </div></section><section class="ej-article-copyright">漏 Congress of Neurological Surgeons 2024. 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}); Sys.Application.add_init(function() { $create(AjaxControlToolkit.ModalPopupBehavior, {"BackgroundCssClass":"Popup-Overlay","DropShadow":true,"PopupControlID":"ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_pnlSubscribeToEtoc","dynamicServicePath":"/onsonline/pages/articleviewer.aspx","id":"subscribeToEtoc"}, null, null, $get("ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_dummyTargetControl")); }); document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_cvEmailError').dispose = function() { Array.remove(Page_Validators, document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_cvEmailError')); } g_QuickLaunchControlIds.push("zz1_TopNavigationMenu");_spBodyOnLoadFunctionNames.push('QuickLaunchInitDroppable'); var g_zz1_TopNavigationMenu = null; function init_zz1_TopNavigationMenu() { if (g_zz1_TopNavigationMenu == null) g_zz1_TopNavigationMenu = $create(SP.UI.AspMenu, null, null, null, $get('zz1_TopNavigationMenu')); 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