Intracranial

venous sinuses

Dr Mohd Imran ANATOMY JNMC AMU 1

 Intracranial venous sinuses
• These are the various venous channels
present in the cranial dura

Formed in the following two ways:

1. By the separation of two layers of
cranial dura
2. By the reduplication of the meningeal
layer
Dr Mohd Imran ANATOMY JNMC AMU 2
 Dural venous sinuses
• Sinuses have thin walls and are lined by
endothelium which is continuous with
that of veins
• Drain blood from brain and skull bones
• Blood from venous sinuses is ultimately
drained into internal jugular veins
• Several of the sinuses communicate
with the veins outside the skull, through
emissary veins
Dr Mohd Imran ANATOMY JNMC AMU 3
 Characteristic Features
1. Lie between the layers of the dura mater
2. Have no muscle in their walls
3. Lined by endothelium only
4. Are devoid of valves in their lumen
5. Receive venous blood and CSF
6. Receive valveless emissary veins which
regulate the blood flow and maintain the
equilibrium of venous pressure within and
outside the skull
Dr Mohd Imran ANATOMY JNMC AMU 4
 23 sinuses
Unpaired sinuses Paired sinuses
1. Superior sagittal 1. Cavernous
2. Inferior sagittal 2. Superior petrosal
3. Straight 3. Inferior petrosal

4. Occipital 4. Transverse
5. Anterior intercavernous 5. Sigmoid

6. Posterior intercavernous 6. Sphenoparietal

7. Basilar venous plexus 7. Petrosquamous
Dr Mohd Imran ANATOMY8. Middle meningeal
JNMC AMU 5
Dr Mohd Imran ANATOMY JNMC AMU 6
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 Cavernous Sinus
• Large venous space
• 2 cm long
• 1 cm wide

Location-
• On either side of the body of sphenoid and
sella turcica in the middle cranial fossa
• Its interior is divided into a number of small
spaces (caverns) by trabeculae
Dr Mohd Imran ANATOMY JNMC AMU 8
Dr Mohd Imran ANATOMY JNMC AMU 9
Floor of the sinus-
• formed by the endosteal layer
Lateral wall, roof and medial wall-
• by the meningeal layer
Medially-
• Roof is continuous with diaphragma sella

Dr Mohd Imran ANATOMY JNMC AMU 10

 Extent
Anteriorly-
• Up to the medial
end of superior
orbital fissure

Posteriorly-
• Up to apex of the
petrous temporal
bone
Dr Mohd Imran ANATOMY JNMC AMU 11
 Relations

Superior-
1. Optic chiasma
2. Optic tract

3. Internal carotid artery

4. Anterior perforated substance

Inferior-
1. Foramen lacerum
2. Junction of body & greater wing of sphenoid
Dr Mohd Imran ANATOMY JNMC AMU 12
Medial-
1. Pituitary gland
(hypophysis
cerebri)
2. Sphenoid air
sinus

Lateral-
1. Temporal lobe (uncus) of cerebral hemisphere
2. Cavum trigeminale containing trigeminal
ganglion

Dr Mohd Imran ANATOMY JNMC AMU 13

Anterior-
1. Superior orbital fissure
2. Apex of the orbit

Posterior-
1. Crus cerebri of
midbrain
2. Apex of the
petrous temporal
bone

Dr Mohd Imran ANATOMY JNMC AMU 14

Structures Present in Lateral Wall of
the Sinus-
From above downward these are as follows:
1. Oculomotor nerve
2. Trochlear nerve
3. Ophthalmic nerve
4. Maxillary nerve

Dr Mohd Imran ANATOMY JNMC AMU 15

 Structures Passing through
Cavernous Sinus-

1. Internal carotid artery surrounded by

the sympathetic plexus of nerves
2. Abducent nerve

Pulsations of the
internal carotid
artery help in
expelling blood
from the sinus
Dr Mohd Imran ANATOMY JNMC AMU 16
 Tributaries of the Cavernous
Sinus
• Cavernous sinus
receives blood
from three
sources:

1. Orbit
2. Meninges
3. Brain
Dr Mohd Imran ANATOMY JNMC AMU 17
 Tributaries of the Cavernous
Sinus
I. From orbit-

1. Superior
ophthalmic vein
2. Inferior
ophthalmic vein
3. Central vein of
retina (sometimes)
Dr Mohd Imran ANATOMY JNMC AMU 18
 Tributaries of the Cavernous
Sinus
II. From meninges-

1. Sphenoparietal
sinus
2. Anterior (frontal)
trunk of the
middle meningeal
vein
Dr Mohd Imran ANATOMY JNMC AMU 19
 Tributaries of the Cavernous
Sinus
III. From brain-

1. Superficial middle
cerebral vein
2. Inferior cerebral
veins (only few)

Dr Mohd Imran ANATOMY JNMC AMU 20

1. Transverse sinus
via superior Communications
petrosal sinus

2. Internal jugular
vein via inferior
petrosal sinus

3. Pterygoid venous
plexus via emissary
veins
Dr Mohd Imran ANATOMY JNMC AMU 21
Communications

4. Facial vein via two routes:

a) Superior ophthalmic vein → angular vein
→ facial vein
b) Emissary veins → pterygoid venous plexus
→ deep facial vein → facial vein
Dr Mohd Imran ANATOMY JNMC AMU 22
5.Opposite cavernous
sinuses via anterior Communications
and posterior
intercavernous
sinuses
6. Superior sagittal
sinus via superficial
middle cerebral vein
and superior
anastomotic vein
7. Internal vertebral
venous plexus via
basilar venous plexus
Dr Mohd Imran ANATOMY JNMC AMU 23
Dr Mohd Imran ANATOMY JNMC AMU 24
 Cavernous sinus thrombosis
• Septic thrombosis of cavernous sinus may
be caused by its numerous communications
• Commonest cause of thrombosis is the
passage of septic emboli from the
dangerous area of the face the through-
• Facial vein-
• Deep facial vein-
• Pterygoid venous plexus-
• Emissary vein
Dr Mohd Imran ANATOMY JNMC AMU 25
 Cavernous sinus thrombosis
Following signs and symptoms:
• Severe pain in the eye and forehead, due to
involvement of the ophthalmic nerve
• Ophthalmoplegia (paralysis of ocular
muscles) due to involvement of the 3rd, 4th
and 6th cranial nerves
• Marked edema of eyelids with exophthalmos,
due to congestion of orbital veins following
obstruction of ophthalmic veins
Dr Mohd Imran ANATOMY JNMC AMU 26
Arteriovenous communication
• If the internal carotid artery is ruptured in
the fracture base of the skull, an
arteriovenous communication/fistula is
established between the artery and
cavernous sinus

• Consequently, arterial blood rushes into the

cavernous sinus, enlarging it and forcing blood
into the connecting veins

Dr Mohd Imran ANATOMY JNMC AMU 27

Arteriovenous communication
Signs and symptoms:
• Pulsating exophthalmos
– eyeball protrudes and pulsates with each
heartbeat
• A loud bruit (loud systolic murmur) is easily
heard over the eye
• Ophthalmoplegia due to involvement of 3rd, 4th
and 6th cranial nerves
• Marked orbital and conjunctival edema due to
raised venous pressure in cavernous sinus
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