Carotid cavernous fistulas result from the unique relations of the cavernous sinus, this being the only anatomical site at which an artery passes directly through a venous channel. Review of surgical anatomy of the tumors involving cavernous sinus. Although a straight intracavernous carotid artery in fetuses can change into an adultlike siphon in infants, there is no information on when or how the unique course of abn is established. In a study of the cavernous sinus in 70 specimens, the lateral wall of the sinus was found to be formed by two layers. The external structure of each cavernous sinus cs is made of four dural walls. Cs is seen just lateral to pituitary gland, enhance brightly. Pdf on jan 1, 2015, pengfei zhang and others published the clinical anatomy of the cavernous sinus find, read and cite all the research. Work focusing on the microsurgical anatomy of the cavernous sinus and its adjacent structures has made a critical contribution to our understanding and capabilities in dealing with neoplasms involving the cavernous sinus. For the surgical approach to lesions around the cavernous sinus cs, triangular spaces around cs have been devised. Since the pioneering work of parkinson, 1 2 several studies have described the microsurgical anatomy and surgical procedures involving the cavernous sinus the cavernous sinus cs or lateral sellar compartment, is a large collection of thinwalled veins creating a cavity bordered by the temporal bone of the skull and the sphenoid bone, lateral to the sella turcica. Thin section coronal contrast enhancing t1 w image is best to identify cs.
These corridors have been related to the position of the intracavernous carotid artery ica. Resection of lesions in the cavernous sinus remains a challenge to neurosurgeons due to its complex anatomy. Introduction in 1734, in a book named an anatomical exposition of the structure of the human body by james benignus winslow 16691770 began the first and only usage of the term cavernous sinus, thinking that it resembled corresponding author. It is only a short time ago that the major concepts of the anatomy of the socalled cavernous sinus were described in detail. Clinical cases are used to illustrate routes to the cavernous sinus and its contents and to demonstrate how the cavernous sinus can be used as a pathway for exposure of deeper structures. Methods five adult cadaveric heads were studied with 0, 30, and 70degree 4mm rodlens endoscopes. However, surgical reduction of such lesions enhances the chances for success of subsequent therapy. It spans from the apex of the orbit to the apex of the petrous temporal bone.
Cavernous sinus thrombosis is a very rare, lifethreatening condition that can affect adults and children in cavernous sinus thrombosis, a blood clot blocks a vein that runs through a hollow. The technique of choice for study is mri, although ct can help recognize and identify some anomalies, such as bone destruction. A clearer understanding of the anatomy of the cavernous sinus has resulted in an increased interest in. The cavernous sinus is located on either side of the pituitary fossa and body of the sphenoid bone between the endosteal and meningeal layers of the dura. To move the model in 3d space, use your mouses left click and drag. Surgical anatomy of the dural walls of the cavernous sinus. The cavernous sinus communicates with several paracavernous sinus venous structures, receiving blood flow from the superficial middle cerebral vein smcv, the sphenoparietal sinus sps, and the superior ophthalmic vein, and draining into the superior and inferior petrosal sinuses and pterygoid and basilar plexuses. Ten triangles around cavernous sinus for surgical approach, described by schematic diagram and three dimensional models with the sectioned images for the surgical approach to lesions around the cavernous sinus cs, triangular spaces around cs have been devised. The normal microsurgical anatomy of cs and the triangular corridors to approach the cs are well described in literature. Unlike other dural venous sinuses, it is divided by numerous fibrous septa into a series of. The paranasal sinus region is one of the most complex areas of the human body and is consequently very difficult to study.
The fundamental knowledge and surgical techni ques that they provided became the standard of excellence for several generations of. Microsurgical anatomy, cavernous sinus, microsurgery. Anatomy of cavernous sinus earliest description of cs by ridley in 1695. Anatomy and surgery of the cavernous sinus springerlink. Since the seminal description of cavernous sinus cs as the anatomical jewel box and surgical no mans land, numerous studies have contributed to the understanding of microsurgical anatomy of cs. Controversy still persists regarding whether cs is a venous channel or a true venous plexus. A single approach is not capable of providing exposure of all parts of the sinus. Owing to the fact that there are no valves in the sinus and its connected veins, the direction of blood flow is dependent on venous pressure.
Cavernous, sinus, anatomy, cavernous, sinus, syndrome, neurology, anatomy, physiology, symptoms, findings, causes, mnemon. An overview of the cavernous sinus anatomy is demonstrated the instructions for use of this and the other following models are as follows. The first approach permits access to a compartment of the cavernous sinus medial to the ica, while a second. The decision of harvey cushing to leave general surgery and concentrate on the infant field of central nervous system surgery was in retrospect a landmark in the history of neurosurgery. Different endoscopic endonasal surgical corridors have been described to gain access to different areas of the cavernous sinus 14, 32. The latter was formed by the sheaths of nerves iii, iv, and v 1,2 plus a reticular membrane extending between the sheaths. This cavity contains the internal carotid artery and several important nerves including the oculomotor nerve, the trochlear nerve, the ophthalmic nerve, the maxillary nerve, and the abducens nerve. Anatomy and surgery of the cavernous sinus ebook, 1989.
In 1965 dwight parkinson 1 was the first to realize an anatomical study and to propose a surgical approach to the cavernous sinus. It is a network of veins that sit in a cavity, approximately 1 x 2 cm in size in an adult. The decision of harvey cushing to leave general surgery and concentrate on the infant field of central. The cavernous sinuses are paired dural venous sinuses gross anatomy. Surgical approach to the cavernous sinus for a trigeminal. Ten triangles around cavernous sinus for surgical approach. Fistulas are divided into direct where the cavernous segment of the carotid artery and the cavernous sinus are in continuity, and indirect where shunts are.
Neuroanatomical study surgical anatomy of the dural walls of the cavernous sinus alvaro camperoa,b, a. Objective the aim of this article is to describe the anatomy of the cavernous sinus and to provide a guide for use when performing surgery in this complex area. Anatomy and surgery of the cavernous sinus vinko v. As such, infections of the face particularly those involving the danger triangle orbits, nasal sinuses, and superior part of the face can cause a cavernous sinus thrombosis. His concentrated work, and also that of his colleague walter dandy, originated with the desires of both pioneers to understand surgical anatomy and neurophysiology.
This membrane was often incomplete, particularly between the sheaths of nerves iii and iv above, and v1 below. Winslow in 1732 gave name cs due to presence of fibrous trabeculae. Seven fresh adult cadavers were studied bilaterally n 14. This basic information will facilitate our surgical procedures and decrease the rate of surgical complications. Endoscopic anatomy and approaches of the cavernous sinus. A long tortuous course of the abducens nerve abn crossing a highly curved siphon of the internal carotid artery is of interest to neurosurgeons for cavernous sinus surgery. The obtained data make the anatomic basis for neurosurgical operations in the cavernous region. We are now fortunate to have a new standard of morbidity and mortality in the surgical. The objectives of this study were to recognize the endoscopic anatomy of the cavernous sinus and to understand the standard, purely endoscopic endonasal approaches to this anatomic structure.
The purpose of this study is to present educational materials about the triangles, consisting of a schematic diagram and 3dimensional 3d models with. Please use the full screen function for optimal visualization by clicking on the arrows on the right lower corner of the model. The veins that communicate with the cavernous sinus are. Microsurgical anatomy and approaches to the cavernous sinus. Although the anatomy of the cavernous sinus is complex, detailed knowledge of this area is essential for safe surgical approaches to the region. Fifty cavernous sinuses from cadavers were studied in detail using magnification, with special attention to the relationships important in surgical approaches on the intracavernous structures, and to understanding arterial contributions to arteriovenous fistulas involving the cavernous sinus. By continuing to use our website, you are agreeing to our use of cookies. Medially, the cavernous sinus is related to the pituitary gland and the sphenoid sinus. In this article, we report the case of a schwannoma of the lateral wall of the cavernous sinus that was surgically treated. Pdf the clinical anatomy of the cavernous sinus researchgate. Anatomy of the cavernous sinus region sciencedirect. This article covers the anatomy and location of the cavernous sinus and helps you to understand the clinical relevance.
The most common surgical approaches involve some variation of the standard frontotemporal craniotomy. T he structure of the cavernous sinus cs has been compared to the hull of a boat, as it is narrow at its anteriormost aspect the transition from the cs into the superior orbital fissure and wide posteriorly where it opens into the venous confluence formed by the basilar and petrosal sinuses. For the surgical approach to lesions around the cavernous sinus cs, triangular spaces around cs. A 55yearold female presented with diplopia, partial ptosis, and facial dysesthesia in the left ophthalmic territory. The management of vascular and tumorous lesions of the parasellar region still remains one of the most demanding tasks in neurosurgery. It is investigation of choice for cavernous sinus lesion. The cavernous sinus cs is a very important concept because it is not only interesting to anatomical theory but also useful to clinical medicine, especially in the field of surgery. The need for detailed vascular anatomy including venous. This paper described the microsurgical anatomy of the cs with special attention to its concept that the cs was really venous sinus or plexus.
Cavernous sinus and abducens nerve in human fetuses near. The direct surgical approach to the cavernous sinus either for vascular malformations or invasive tumors treatment is now largely accepted. Cavernous sinus thrombosis the veins of the face drain blood into the cavernous sinus via the superior ophthalmic vein. However, educational materials for learning the triangles were insufficient. The cavernous sinus has several venous connections that add further clinical significance to the.
Relevant dural, arterial, venous and cranial nerve anatomy is presented. The cavernous sinus is a centrally located cavity situated at the base of the brain next to the temporal bone and sphenoid bone. Matula department of neurosurgery, medical school, university of vienna, austria summary the cavernous sinus is divided from the surgical point of view into three parts. Despite the development of the microsurgical technique in the seventies, it was thought that microneurosurgery was reaching its. Surgical anatomy of the sphenoid sinus cambridge core. Review of surgical anatomy of the tumors involving. Departmental guidelines anatomy cavernous sinus 2cm in length, height of 1cm paired venous sinus, on either side of body of sphenoid.
The surgical anatomy of the nose and paranasal sinuses is published with great detail in most standard textbooks, but it is the purpose of this chapter to describe those structures in a very clear and systematic. The following we use cookies to enhance your experience on our website. Dural venous sinuses, cavernous sinus thrombosis, cavernous sinus syndrome, caroticocavernous fistula, triangular space near the cavernous sinus. Schwannomas of the cavernous sinus are very rare and usually originate from the trigeminal nerve, though cases originating from the oculomotor nerves and from the carotid plexus have also been described in the literature 110.
In the pdf file, clinical approaches were marked at the book. Pdf the lesions involving cavernous sinus cs and lateral sellar region includes tumors, vascular lesions, infection, inflammation, and trauma find, read. Surgical measurement to sphenoid sinus for the chinese in asia based on ct using sagittal reconstruction images. The cavernous sinus a multidisciplinary approach to. Tumors involving the cavernous sinus clinical gate. The surgical anatomy of the human cavernous sinus has been described by several authors. Traversed by numerous trabeculae, dividing it into a several caverns spaces, hence cavernous sinus relations. His concentrated work, and also that of his colleague walter dandy, originated with the desires of both pioneers. Cavernous sinus anatomy the neurosurgical atlas, by. Cavernous sinus anatomy and clinical relevance lecturio. Ten cadaveric dissections were therefore performed to examine the microsurgical anatomy of the cavernous sinus.
Introduction the anatomy of the cavernous sinus has been the sub. This video presents the most relevant landmarks of the cavernous sinus region, helping to understand the surgical anatomy. Anatomy and surgery of the endoscopic endonasal approach. Laterally, it is related to the temporal lobe of the brain. Anatomy and surgery of the cavernous sinus softcover reprint of the original 1st ed. Agustin camperoa, carolina martinsb, alexandre yasudab, albert l. The endoscopic surgical anatomy of the cavernous sinus was studied to establish an anatomic basis for endoscopic endonasal cavernous sinus surgery. Cavernous sinus surgery approach through the lateral wall a. The cavernous sinus is an unconventional venous system in the sense that it does not have a unidirectional flow of blood.
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