Cavernous sinus anatomy

Lectures of Anatomy by Dr. Noura El Tahawy for second year Faculty of Medicine

1. Cavernous Sinus

By
Dr. Noura El Tahawy

2. Position & Extension

-on the side of the body of sphenoid,
-extending from the apex of the petrous temporal bone (behind)

to the medial end of the superior orbital fissure (in front).

-Each sinus is 2 cm long and 1 cm wide,

3. Dural Venous Sinuses
Cranial Floor - Superior View

Hypophysis (pituitary gland)
Optic nerve (0

Internal carotid artery
Suparor aphthalmicveln à j Oeulomator nen aid
Anterior and postilor

Interesvemeur

Superficial misate

Cavernous sinus

venous plows

Superior
petiralsinus —

Tantorium
Esteban —2

Interior sagittal
Erz Tranpesira sinor
‘Accessory ne Gt)
Hypoglessal nerve DD

Great cerebral vein (Galen)

5. Relations

6. Medially:
Sphenoidal air sinus.
Hypophysis cerebri.

Laterally:
Trigeminal ganglion.
Uncus of the temporal lobe.

Nerves in its lateral wall: (from above downwards)
Oculomotor nerve.

Trochlear nerve.

Ophthalmic division of trigeminal nerve.

Maxillary division of trigeminal nerve.

Structures within its cavity.

Internal carotid artery.

Abducent nerve (on the lateral side of the artery).

-carotid sympathetic plexus

N.B.: The internal carotid artery may rupture inside the cavernous sinus due to
fracture base of the skull. This results in a pulsating swelling behind the orbit.

7. Coronal section of the cavernous sinus.

Anterior cerebral artery
Middle cerebral artery
Hypophysis

Cavernous sinus

Endosteum

Sphenoidal air sinus

Greater wing of sphenoid

Optic nerve
Diaphragma sellae

Free edge of
tentorium cerebelli

Subarachnoid space

Internal carotid artery |Sympathetic fibers

8. Cavernous sinus.
Trochlear nerve [IV] Abducent nerve [Vi]

Internal carotid arte
Oculomotor nerve [ll]

Pituitary gland Dura mater

Diaphragma seltae

|
Ophthalmic division of trigeminal nerve [V,]

lary division of trigeminal nerve [Vy]

9. Dural Venous Sinuses
Coronal Section Through Cavernous Sinus

10. Cavernous Sinuses

Optic Chiasma

Internal Carotid Artery

Sphenoid Bone

11. Medial end of
The superior orbital fissure

Optic Chaisma

Temporal lobe

Apex of petrous

Trigeminal Ganglion

12. Content of the Cavernous Sinuses

Occulomotor Nerve

Trochlear Nerve

Ophthalmic Nerve

Maxillary Nerve

Internal carotid Artery
Abducent Nerve with

‘Sympathetic Plexus

13. Tributaries and
communications

14. Anteriorly:
* Ophthalmic veins (connect it with the facial vein in the face)
* Sphenoparietal sinus.

Posteriorly:
+ Superior petrosal sinus (connects it with the transverse sinus).
+ Inferior petrosal sinus (connects it with the internal jugular vein).

Medially:

+ Anterior and posterior intercavernous sinuses (connect the 2cavernous sinuses together).

Superiorly:

+ Superficial middle cerebral vein (from the lateral surface of the
+ brain).

+ Cerebral veins from the inferior surface of the brain.

Inferiorly:
+ Emissary vein through the carotid canal (conneets it with the internal jugular vein),

+ Emissary vein through the foramen ovale (connects it with the pterygoid plexus of
veins).

17. Tributaries of Cavernous Sinus

Anteriorly, Posteriorly, Medially and Superiorly

18. Superior petrosal
sinus

Inferior cerebral

Superficial middle
Cerebral vein

Sphenoparietal sinus

Inferior cerebral
veins

Superficial middle
Cerebral vein

Sphenoparietal sinus

19. Inferior
Tributaries of Cavernous Sinus

20. q QD soramen vesaius

Foramen Ovale

D

ForameMacerum

Pharyngeal Pterygoid
Plexus Plexus

21. 1- Superior Ophthalmic Vein
2- Inferior Ophthalmic Vein

3- Sphenoparietal sinus

4- Anterior Facial Vein

8- Inferior Petrosal Sinus

Pharyngeal
Plexus

'oramen Vesalius

D
D LE Ovale

Foramen acerum

Pterygoid
Plexus

22. Anterior and poster

Supericial middle
aerea a

cavernous sinus

venous plus

Sup

inferior

inte
serebra vel
nae u —
Straight sinus

Fate carebi cout)

Con

Dural Venous Sinuses
Cranial Floor - Superior View

Hypophysic (pituitary gland)
Optic nerve (I
Internal catotid artery

Oculomotor name ily

Trochtear nerve CD

Ophihalmio nerve un
Masdilary neve (v2)

Trigeminal ganglion

» ua

Stossophayngeal (2
ane vague Go nanes

Tranaveres sinus
Accassory nerve (XD
Hypoglossal nerve Gxt)

Great cerebral vein (oalen)

23. Dangerous area of the Face

24. -The flow of blood in all the tributaries and communications of the
cavernous sinus is reversible because they possess no valves.
-Spread of infection to the cavernous sinus leads to its thrombosis.

-The cavernous sinus communicates with the veins draining the
middle area of the face (dangerous area of the face) through 2
routes:

1-Superior ophthalmic vein.

2-Deep facial vein, pterygoid plexus of veins and emissary vein
through the foramen ovale.

25. Cavernous Sinus Thrombosis

26. If the cavernous sinus is thrombosed what are the important structures that
may be affected??
Q. What is the clinical picture of CST ?

A. Clinical features of CST
General features of infection: fever, rigors, malaise, and sever frontal and orbital headache.
Unilateral exophthalmos and tender eye ball
edema of the eyelid and chemosis of the conjunctiva (due to obstruction of the superior and inferior ophthalmic veins).
Third, fourth, sixth cranial nerves and ophthalmic and maxillary divisions of the fifth cranial nerve may be affected
(paralysis or paresis):
* Clinical picture of oculomotor par:
— External ophthalmoplegia: Paralysis of movements of the affected eye (upward, downward and medial). Ptosis: due
to paralysis of the levator palpebrae superioris, Slight exophthalmos,
- Internal ophthalmoplegia: Dilated fixed pupil with loss of accommodation reflex. (due to paralysis of the sphincter
papillae and cilliary muscles)
“Paralysis of abducent nerve: Paralysis of outward movement of the affected eye.( due to paralysis of lateral rectus
muscle)
* Paralysis of trochlear nerve: Paralysis of outward and downward movement of the affected eye. (due to paralysis of
superior oblique muscle)
* Anesthesia in the distribution of ophthalmic division of the trigeminal nerve, decreased or absent comeal reflex and
possibly anesthesia in the maxillary branch distribution
5 . Infection can spread to the contralateral cavernous sinus within 24-48 hr of initial presentation. The earliest feature of
such spread is affection of the abducent nerve (6 th cranial nerve) on the opposite side (paralysis of outward movement of the
affected eye)

27. Thanks