Sinus headache and nasal disease
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby in Headache in Clinical Practice, 2018
The roof of the sphenoid sinus is related to the middle cranial fossa and the pituitary gland in the sella turcica; lateral is the cavernous sinus; posterior is the clivus and pons; anterior are the posterior nasal cavity, posterior ethmoid cells, and cribriform plate; and inferior is the nasopharynx. The cavernous sinus (which is lateral to the sphenoid sinus) contains the internal carotid arteries and the illrd, IVth, Vth, and Vlth cranial nerves. The maxillary division of the Vth nerve may indent the wall of the sphenoid sinus. The sphenoid walls can be extremely thin, and sometimes the sinus cavity is separated from the adjacent structure by just a thin mucosal barrier. Because of the close proximity to the cortical venous system, cranial nerves, and meninges, infection may spread to these structures and present as a central nervous system infection or neurological catastrophe.2,37
The Governor Vessel (GV)
Narda G. Robinson in Interactive Medical Acupuncture Anatomy, 2016
Cavernous sinus thrombosis typically occurs as a late complication of infection affecting the central portion of the face (in the danger triangle) or paranasal sinuses. Maxillary tooth or otic infection, bacteremia, and trauma can also cause cavernous sinus thrombosis. Without appropriate antimicrobial agents, intracranial septic thrombosis of the cavernous sinus may produce devastating complications due to the myriad neuro-vascular connections made in the sinuses. The internal carotid artery courses within the cavernous sinuses along with the sympathetic plexus that surrounds it. Cranial nerves supplying extraocular muscles, i.e., CN III, IV, and VI, follow its lateral walls. Trigeminal nerves from the ophthalmic and maxillary divisions travel within the walls.
Neuroanatomy
Ibrahim Natalwala, Ammar Natalwala, E Glucksman in MCQs in Neurology and Neurosurgery for Medical Students, 2022
The structures that pass through the cavernous sinus are the oculomotor nerve, trochlear nerve, ophthalmic and maxillary divisions of the trigeminal nerve, abducens nerve and the internal carotid artery.8 The optic nerve passes superiorly and exteriorly to the cavernous sinus. The sinus itself receives a venous blood supply from the ophthalmic vein. Thus, the cavernous sinus is unique since an artery passes through a venous structure. A rupture of the internal carotid artery will cause an arterio-venous fistula (it is possible to hear an orbital bruit).9 Patients can present with ophthalmoplegia, fixed dilated pupil, ptosis, proptosis, chemosis and facial pain. Treatment involves either neuroendovascular or neurosurgical approaches.
Cavernous sinus fungal infection: a rare case
Published in British Journal of Neurosurgery, 2019
Boon Han Kevin Ng, Giat Seng Kho, Sze Kiat Sim, Donald Ngian San Liew, Ing Ping Tang
Cavernous sinuses are irregularly shaped cavities which are situated at the base of skull. The proximity of the cavernous sinuses to structures such as the internal carotid artery, third, fourth and fifth (V1,V2 branches) cranial nerves make any infection of the cavernous sinus a serious condition. Fungal infection can spread via blood or from direct extension from the paranasal sinuses, orbit or middle ear1. Gram positive organisms such as Staphylococcus aureus are more commonly the cause of infection2. A study in India on 66 patients with intracranial fungal infection reported that the most common location of the fungal infection is the anterior cranial fossa (53%), followed by the middle cranial fossa (30%), and the posterior cranial fossa(0.06%)1. Fungal infection of the cavernous sinus is an uncommon occurrence. The incidence is however on the rise partly due to large ageing population, use of immunosuppressive drugs and an increase in AIDS. Risk factors include diabetes, tuberculosis and HIV1,2. The above patient however, did not have any of the above predisposing risk factors.
Isolated Ocular Motor Nerve Palsies
Published in Journal of Binocular Vision and Ocular Motility, 2018
Stacy L. Pineles, Federico G. Velez
All three ocular motor nerves travel through the subarachnoid space at the skull base and into the cavernous sinus. Within the cavernous sinus, they are adjacent to the first and second division of the trigeminal nerve, the internal carotid artery, and the third-order oculosympathetic fibers. In the cavernous sinus, the oculomotor nerve divides into superior and inferior divisions which innervate the (1) superior rectus and LPS and (2) the inferior rectus, inferior oblique, medial rectus, and pupillary sphincter, respectively. The nerves then exit the cavernous sinus and traverse the orbit. CNIII and CNVI are positioned within the annulus of Zinn, while CNIV lies outside of the annulus of Zinn. In-depth knowledge of the pathways of the ocular motor nerves as well as adjacent structures provides clinicians with the knowledge required to understand various clinical presentations of CN palsies with coexistent neurological syndromes.
The Effects of Acute Intracranial Pressure Changes on the Episcleral Venous Pressure, Retinal Vein Diameter and Intraocular Pressure in a Pig Model
Published in Current Eye Research, 2021
Deepta Ghate, Sachin Kedar, Shane Havens, Shan Fan, William Thorell, Carl Nelson, Linxia Gu, Junfei Tong, Vikas Gulati
We acknowledge inter-species differences in vascular and orbital anatomy between humans and pigs. The internal carotid artery in humans lies within the cavernous sinus. In pigs and other ungulates, the cavernous sinus is filled with a network of arteries (rostral epidural rete mirabile) from which forms the rostral part of the internal carotid artery.18 The pig optic nerve head has a larger diameter compared to the human optic nerve head and has 5–6 laterally placed retinal arteries while the human optic nerve head has a single retinal artery placed centrally.52 These differences in arterial anatomy do not affect our study of venous parameters, since the porcine ophthalmic venous anatomy is similar to the human eye.53 The porcine optic nerve head has a single centrally placed retinal vein that exits the eye through the lamina cribrosa, like humans. The venous drainage from the choroid and anterior segment occurs through the vortex vein and episcleral vein, with drainage into the cavernous sinus. Thus, the basic schema of the intra-cranial, intra-orbital and ocular anatomy is comparable between humans and pigs for the purposes of our study of changes in EVP, IOP and RVD in response to acute ICP changes. Although our study included a small number of animals, the study hypothesis and results are consistent with known anatomic and physiologic principles that regulate the fluid and vascular pressure within the cranial and orbital compartments. Our study methodology has a statistically robust basis and the outcomes find support in the numerous human and animal studies described above.
Related Knowledge Centers
- Internal Carotid Artery
- Optic Tract
- Skull
- Sphenoid Bone
- Temporal Bone
- Dura Mater
- Pituitary Gland
- Sella Turcica
- Dural Venous Sinuses
- Sinus