Cavernous Sinus

By

Dr. Noura El Tahawy

-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,

Position & Extension

Relations

* 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.

Coronal section of the cavernous sinus.

Cavernous sinus.

Cavernous SinusesOptic Chiasma

Internal Carotid Artery

Body

of

Sphenoid Bone

Sphenoidal

Air Sinus

Uncus

of

Temporal Lobe

Pituitary

Gland

Sphenoidal

AirSinuses

Temporal lobe

Uncus

Trigeminal Ganglion

Medial end of

The superior orbital fissure

Apex of petrous

Optic Chaisma

Content of the Cavernous Sinuses

Internal carotid Artery

with

Sympathetic Plexus

Abducent Nerve

Occulomotor Nerve

Trochlear Nerve

Ophthalmic Nerve

Maxillary Nerve

Tributaries and

communications

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 (connects it with the internal jugular vein).

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

Superior and inferior

Ophthalmic veins

inferior

Petrosal sinus

Plexus of emissary veins through

carotid canal to internal jugular vein

Tributaries of Cavernous Sinus

Anteriorly, Posteriorly, Medially and Superiorly

Superior ophthalmic vein

Inferior ophthalmic vein

Inferior ophthalmic vein

Central vein of

the retina

Central vein of

the retina

Sphenoparietal sinus

Sphenoparietal sinus

Superior ophthalmic vein

Left Cavernous SinusRi

ght Cavernous Sinus

Superior petrosal

sinus

Superior petrosal

sinus

Inferior petrosal

sinus

Inferior petrosal

sinus

Intercavernous

sinuses

Superficial middle

Cerebral vein

Superficial middle

Cerebral vein

Inferior cerebral

veins

Inferior cerebral

veins

Inferior

Tributaries of Cavernous Sinus

Left Cavernous SinusRi

ght Cavernous Sinus

Foramen Lacerum

Foramen Ovale

Foramen Vesalius

Pharyngeal

PlexusPterygoid

Plexus

Left Cavernous SinusRi

ght Cavernous Sinus

Foramen Lacerum

Foramen Ovale

Foramen Vesalius

Pharyngeal

PlexusPterygoid

Plexus

1- Superior Ophthalmic Vein

2- Inferior Ophthalmic Vein

3- Sphenoparietal sinus

4- Anterior Facial Vein

8- Inferior Petrosal Sinus

Dangerous area of the Face

-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 veinthrough the foramen ovale.

Cavernous Sinus Thrombosis

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

• Oedema 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 paralysis:

– 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 corneal 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).

Thanks