View revision history Report problem with Article. Citation, DOI and article data. Gaillard, F. Cavernous sinus. Reference article, Radiopaedia. Vascular , Central Nervous System. URL of Article. Gross anatomy The cavernous sinus is located on either side of the pituitary fossa and body of the sphenoid bone between the endosteal and meningeal layers of the dura.
Nerves The cavernous sinus transmits multiple cranial nerves to the superior orbital fissure and foramen rotundum. These are: in the lateral wall from superior to inferior oculomotor nerve CN III trochlear nerve CN IV trigeminal nerve CN V ophthalmic division maxillary division: within the very inferolateral aspect of the cavernous sinus wall or even outside the sinus rather than truly within it 4 traversing the sinus abducens nerve CN VI : inferolateral to the internal carotid artery Artery The internal carotid artery enters the posterior inferior aspect of the sinus and bends upon itself as the carotid siphon cavernous segment - C4.
The artery is surrounded by a plexus of sympathetic nerves from the superior cervical ganglion. Fat Fatty deposits may be present within the cavernous sinus, especially in obese patients or in those who are taking corticosteroids 3. Related pathology cavernous sinus syndromes cavernous sinus thrombosis caroticocavernous fistula cavernous sinus mass. Quiz questions. Standring S, Gray H. Gray's anatomy, the anatomical basis of clinical practice.
Churchill Livingstone. Read it at Google Books - Find it at Amazon. Related articles: Anatomy: Brain. Related articles: Anatomy: Head and neck. Promoted articles advertising. Case 1a: labeled 20 Case 1a: labeled Case 1b: labeled 19 Case 1b: labeled Case 1c: labeled 46 Case 1c: labeled Figure 1 Figure 1. Loading more images Close Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. The infection may cause thrombosis within the facial veins; when the clot breaks off and travels to the cavernous sinus, it can cause CST.
As well, due to the close relationship of the cavernous sinus to the paranasal sinuses, orbit, complex of veins, cranial nerves, internal carotid artery, and meninges, and the absence of valves in the veins draining to and from the cavernous sinus, infection from draining tissues can result in CST.
The condition is characterized by edema of the eyelids, conjunctiva, and paralysis of the cranial nerves closely related to the cavernous sinuses. Common organisms involved in CST include Staphylococcus aureus , Streptococcus pneumococcus , gram-negative bacteria , anaerobes, and fungi such as Rhizopus and Aspergillus.
Diagnosis of CST is done clinically and confirmed with either computed tomography CT scan or magnetic resonance imaging with magnetic resonance venogram , which is the study of choice. Treatment consists of empirical broad-spectrum antibiotics with corticosteroids to reduce edema.
Delay in diagnosis and treatment is associated with high morbidity and mortality. Patients who survive may have a visual impairment or cranial nerve deficits. The pituitary gland is located in a fossa between the two cavernous sinuses. As pituitary tumors grow, they can expand toward and then compress the cavernous sinus. CSS can also be caused by tumors extending from the nasopharynx, pituitary, or metastasis, or even following CST. Carotico-cavernous fistula CCF is formed via an unnatural direct communication between the cavernous sinus and the ICA traversing through it.
This direct fistula is formed due to either trauma or rupture of an aneurysm. Arterial dissection , collagen vascular diseases such as Ehler-Danlos syndrome, and fibromuscular dysplasia can also cause CCF. Among other symptoms, patients may present with pulsatile proptosis; orbital congestion; chemosis; corneal exposure; diplopia; paralysis of CN III, IV, and VI; and retinopathy.
CT angiography is the test of choice. Usually, these fistulae resolve spontaneously. Persistent symptomatic fistulae require treatment, which consists of steroids in the acute phase to reduce edema followed by definitive surgery.
Endovascular approaches with obliteration of the fistula and restoration of arterial and venous flow lead to resolution of the fistula. In , Parkinson described a triangular space between the ophthalmic and trochlear nerves that can be used to approach lesions near the cavernous part of the ICA.
With the advent of radiosurgery and endovascular surgery, this direct approach through the triangular space is rarely required, however. If endovascular surgery or occlusion of carotico-cavernous fistula fails, then direct surgery through this space may be necessary.
As well, in the case of certain tumors such as meningiomas, schwannomas, pituitary adenomas, and chondromas , access to the tumors can be gained through this triangle. Cavernous sinus via wikipedia. Cavernous Sinus Thrombosis via medscape. Definition of Cavernous sinus via medicinenet. Cavernous sinus via radiopaedia. Rate this article Votes: 7, average: 4. About the Lecturio Medical Online Library Our medical articles are the result of the hard work of our editorial board and our professional authors.
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