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Cavernous sinus

by
Ademola A. Oremosu
MB;BS, M.Sc, Ph.D

Located on either side of the sella turcica
In middle cranial fossa
Upper part of the sphenoid bone
Walls of veins are extremely thin
Extent- anteriorly (superior orbital fissure)
to posteriorly (apex of petrous temporal
bone)
Cavernous Sinus: Anatomy
Tributaries
Superior ophthalmic veins
Inferior ophthalmic veins
Superficial middle cerebral vein
Sphenoparietal sinus
Central vein of retina
Cavernous Sinus: Anatomy
Pc-post clinoid
Process
Ac-ant clinoid
process
FR- foramen
Rotundum
Se-Sella turcica
SOF-sup orbital
Fissure
CC-carotid canal
OF-orbital fissure
Venous channels
Each sinus communicates with the other
anterior and posterior to the pituitary stalk-
intercavernous sinuses
Sometimes throu veins inferior to pituitary
gland

Cavernous Sinus: Anatomy
Drainage
Postero-inferiorly:
superior petrosal sinuses, then into
transverse sinus
inferior petrosal sinuses, then into
into internal jugular vein
Emissary veins to the pterygoid
plexuses
Cavernous Sinus: Drainage
Cavernous Sinus: Anatomy
Contents and relations
Inside the sinus are
Internal carotid artery with sympathetetic
plexuses and small branches
Abducent nerve (CN VI)
Lateral wall:
Occulomotor (CN III), Trochlear (CN IV),
and V1, V2
Cavernous Sinus: Anatomy
Cavernous Sinus: Anatomy
Cavernous Sinus: Anatomy
Cavernous Sinus: Anatomy
Cavernous Sinus: Anatomy
A: ICA
B: CN III
C: CN
IV
D: CN
VI
E: CN
V
1
F: CN
V
2
Important communications
With facial vein through superior opthalmic
vein
Thrombosis of the cavernous sinus can
occur from infections
in the orbit
nasal air sinuses
superior part of the face
Cavernous Sinus: Tributaries
Facial infections
Area of facial skin bounded by nose, the
eye & upper lip is DANGEROUS ZONE
(danger triangle)
Boil in this region can lead to thrombosis of
facial vein
Organism spread through inferior opthalmic
vein to the cavernous sinus
Causes cavernous sinus thrombosis
Used to be fatal (pre antibiotic era)
Can be treated with antibiotics
Thrombophlebitis (TMPB)
Thrombophlebitis of facial vein
Infected thrombose may reach cavernous sinus
Leading to thrombophlebitis of cavernous sinus
Initially one sinus affected
Spread to opposite side through intercavernous
sinus
May affect CN VI & OTHER NERVES IN
LATERAL WALL
Septic TMPB may lead to acute meningitis
Fracture of cranial base
Internal carotid artery may be torn
Produces artero venous fistula
Arterial blood rushes into cavernous sinus
Retrograde blood flow into venous
tributaries
Especially ophthalmic veins
Eyeball protrudes (Exopthalmos)
Conjuctiva becomes engorged (chemosis)
Protruding eyeball pulsates in synchrony
with radial pulse- pulsating exophthalmos
Nerves CN III,IV,V1,V2,CN VI may be
affected

Cavernous Sinus:
Neuroimaging