The cavernous sinus within the human head is one of the

dural venous sinuses The dural venous sinuses (also called dural sinuses, cerebral sinuses, or cranial sinuses) are venous sinuses (channels) found between the periosteal and meningeal layers of dura mater in the brain. They receive blood from the cerebral veins, ...

creating a cavity called the lateral sellar compartment bordered by the

temporal bone The temporal bone is a paired bone situated at the sides and base of the skull, lateral to the temporal lobe of the cerebral cortex. The temporal bones are overlaid by the sides of the head known as the temples where four of the cranial bone ...

of the

skull The skull, or cranium, is typically a bony enclosure around the brain of a vertebrate. In some fish, and amphibians, the skull is of cartilage. The skull is at the head end of the vertebrate. In the human, the skull comprises two prominent ...

and the

sphenoid bone The sphenoid bone is an unpaired bone of the neurocranium. It is situated in the middle of the skull towards the front, in front of the basilar part of occipital bone, basilar part of the occipital bone. The sphenoid bone is one of the seven bon ...

, lateral to the

sella turcica The sella turcica (Latin for 'Turkish saddle') is a saddle-shaped depression in the body of the sphenoid bone of the human skull and of the skulls of other hominids including chimpanzees, gorillas and orangutans. It serves as a cephalometric la ...

Structure

The cavernous sinus is one of the dural venous sinuses of the head. It is a network of veins that sit in a cavity. It sits on both sides of the sphenoidal bone and

pituitary gland The pituitary gland or hypophysis is an endocrine gland in vertebrates. In humans, the pituitary gland is located at the base of the human brain, brain, protruding off the bottom of the hypothalamus. The pituitary gland and the hypothalamus contr ...

, approximately 1 × 2 cm in size in an adult. The carotid siphon of the

internal carotid artery The internal carotid artery is an artery in the neck which supplies the anterior cerebral artery, anterior and middle cerebral artery, middle cerebral circulation. In human anatomy, the internal and external carotid artery, external carotid ari ...

, and cranial nerves III, IV, V (branches V₁ and V₂) and VI all pass through this blood filled space. Both sides of cavernous sinus are connected to each other via intercavernous sinuses. The cavernous sinus lies in between the inner and outer layers of dura mater.

Nearby structures

* Above:

optic tract In neuroanatomy, the optic tract () is a part of the visual system in the brain. It is a continuation of the optic nerve that relays information from the optic chiasm to the ipsilateral lateral geniculate nucleus (LGN), pretectal nuclei, and su ...

optic chiasma In neuroanatomy, the optic chiasm, or optic chiasma (; , ), is the part of the brain where the optic nerves cross. It is located at the bottom of the brain immediately inferior to the hypothalamus. The optic chiasm is found in all vertebrates, ...

. * Inferiorly:

foramen lacerum The foramen lacerum () is a triangular hole in the base of the skull. It is located between the sphenoid bone, the apex of the petrous part of the temporal bone, and the basilar part of the occipital bone. Structure The foramen lacerum () is a ...

, and the junction of the body and

greater wing of sphenoid bone The greater wing of the sphenoid bone, or alisphenoid, is a bony process of the sphenoid bone, positioned in the skull behind each eye. There is one on each side, extending from the side of the body of the sphenoid and curving upward, laterally ...

. * Medially: pituitary gland (hypophysis cerebri), and sphenoidal air sinus. * Laterally:

temporal lobe The temporal lobe is one of the four major lobes of the cerebral cortex in the brain of mammals. The temporal lobe is located beneath the lateral fissure on both cerebral hemispheres of the mammalian brain. The temporal lobe is involved in pr ...

with

uncus The uncus is an anterior extremity of the parahippocampal gyrus. It is separated from the apex of the temporal lobe by a sulcus called the rhinal sulcus. Although superficially continuous with the hippocampal gyrus, the uncus forms morphol ...

. * Anteriorly:

superior orbital fissure The superior orbital fissure is a foramen or cleft of the skull between the lesser and greater wings of the sphenoid bone. It gives passage to multiple structures, including the oculomotor nerve, trochlear nerve, ophthalmic nerve, abducens nerve ...

, and the apex of the orbit. * Posteriorly: apex of

petrous temporal bone The petrous part of the temporal bone is pyramid-shaped and is wedged in at the base of the skull between the sphenoid bone, sphenoid and occipital bones. Directed medially, forward, and a little upward, it presents a base, an apex, three surface ...

Venous connections

The cavernous sinus receives blood from: *

Superior Superior may refer to: *Superior (hierarchy), something which is higher in a hierarchical structure of any kind Places * Superior (proposed U.S. state), an unsuccessful proposal for the Upper Peninsula of Michigan to form a separate state *Lak ...

and

inferior ophthalmic vein The inferior ophthalmic vein is a vein of the orbit that - together with the superior ophthalmic vein - represents the principal drainage system of the orbit. It begins from a venous network in the front of the orbit, then passes backwards throug ...

s * Sphenoparietal sinus * Superficial middle cerebral veins * Inferior cerebral veins Blood leaves the sinus via

superior Superior may refer to: *Superior (hierarchy), something which is higher in a hierarchical structure of any kind Places * Superior (proposed U.S. state), an unsuccessful proposal for the Upper Peninsula of Michigan to form a separate state *Lak ...

and

inferior petrosal sinus The inferior petrosal sinuses are two small sinuses situated on the inferior border of the petrous part of the temporal bone, one on each side. Each inferior petrosal sinus drains the cavernous sinus into the internal jugular vein. Structure Th ...

es as well as via the

emissary veins The emissary veins connect the extracranial venous system with the intracranial venous sinuses. They connect the veins outside the cranium to the venous sinuses inside the cranium. They drain from the scalp, through the skull, into the larger men ...

through the

foramina of the skull This article lists Foramen, foramina that occur in the human body. __TOC__ Skull The human skull has numerous openings (foramen, foramina), through which cranial nerves, arteries, veins, and other structures pass. These foramina vary in siz ...

(mostly through foramen ovale). There are also connections with the

pterygoid plexus The pterygoid plexus (;Entry "pterygoid"
in

of veins via

, deep facial vein and emissary veins.

Apart from the blood which passes through a venous sinus, several anatomical structures, including some

cranial nerves Cranial nerves are the nerves that emerge directly from the brain (including the brainstem), of which there are conventionally considered twelve pairs. Cranial nerves relay information between the brain and parts of the body, primarily to and f ...

and their branches, also pass through the sinus. Structures within the outer (lateral) wall of the compartment from superior to inferior: *

Oculomotor nerve The oculomotor nerve, also known as the third cranial nerve, cranial nerve III, or simply CN III, is a cranial nerve that enters the orbit through the superior orbital fissure and innervates extraocular muscles that enable most movements o ...

Trochlear nerve The trochlear nerve (), ( lit. ''pulley-like'' nerve) also known as the fourth cranial nerve, cranial nerve IV, or CN IV, is a cranial nerve that innervates a single muscle - the superior oblique muscle of the eye (which operates through the pu ...

* Ophthalmic and maxillary branches of the

trigeminal nerve In neuroanatomy, the trigeminal nerve (literal translation, lit. ''triplet'' nerve), also known as the fifth cranial nerve, cranial nerve V, or simply CN V, is a cranial nerve responsible for Sense, sensation in the face and motor functions ...

Structures passing through the midline (medial) wall: *

Abducens nerve The abducens nerve or abducent nerve, also known as the sixth cranial nerve, cranial nerve VI, or simply CN VI, is a cranial nerve in humans and various other animals that controls the movement of the lateral rectus muscle, one of the extraocula ...

Internal carotid artery The internal carotid artery is an artery in the neck which supplies the anterior cerebral artery, anterior and middle cerebral artery, middle cerebral circulation. In human anatomy, the internal and external carotid artery, external carotid ari ...

accompanied by the

internal carotid plexus The internal carotid plexus is a nerve plexus situated upon the lateral side of the internal carotid artery. It is composed of post-ganglionic sympathetic fibres which have synapsed at (i.e. have their nerve cell bodies at) the superior cervical g ...

These nerves, with the exception of CN V₂, pass through the cavernous sinus to enter the orbital apex through the

. The maxillary nerve, division V₂ of the trigeminal nerve travels through the lower portion of the sinus and exits via the

foramen rotundum The foramen rotundum is a circular hole in the sphenoid bone of the skull. It connects the middle cranial fossa and the pterygopalatine fossa. It allows for the passage of the maxillary nerve (V2), a branch of the trigeminal nerve. Structure T ...

. The maxillary branch passes external to, but immediately adjacent to, the lateral wall of the sinus. The

optic nerve In neuroanatomy, the optic nerve, also known as the second cranial nerve, cranial nerve II, or simply CN II, is a paired cranial nerve that transmits visual system, visual information from the retina to the brain. In humans, the optic nerve i ...

lies just above and outside the cavernous sinus, superior and lateral to the

on each side, and enters the orbital apex via the

optic canal The ''optic foramen'' is the opening to the optic canal. The canal is located in the sphenoid bone; it is bounded medially by the body of the sphenoid and laterally by the lesser wing of the sphenoid. The superior surface of the sphenoid bone is ...

Function

Venous drainage

As a venous sinus, the cavernous sinus receives blood from the

and

s and from superficial cortical veins, and is connected to the basilar plexus of veins posteriorly. The cavernous sinus drains by two larger channels, the superior and

es, ultimately into the internal jugular vein via the sigmoid sinus, also draining with emissary vein to

pterygoid plexus The pterygoid plexus (;Entry "pterygoid"
in

Clinical significance

It is the only anatomic location in the body in which an

artery An artery () is a blood vessel in humans and most other animals that takes oxygenated blood away from the heart in the systemic circulation to one or more parts of the body. Exceptions that carry deoxygenated blood are the pulmonary arteries in ...

travels completely through a venous structure. If the internal carotid artery ruptures within the cavernous sinus, an ''

arteriovenous fistula An arteriovenous fistula is an abnormal connection or passageway between an artery and a vein. It may be congenital, surgically created for hemodialysis treatments, or acquired due to pathologic process, such as trauma or erosion of an arteri ...

'' is created (more specifically, a

carotid-cavernous fistula A carotid-cavernous fistula results from an abnormal communication between the arterial and venous systems within the cavernous sinus in the skull. It is a type of arteriovenous fistula. As arterial blood under high pressure enters the cavernous ...

). Lesions affecting the cavernous sinus may affect isolated nerves or all the nerves traversing through it. The

lies between the two paired cavernous sinuses. An abnormally growing

pituitary adenoma Pituitary adenomas are tumors that occur in the pituitary gland. Most pituitary tumors are benign, approximately 35% are invasive and just 0.1% to 0.2% are carcinomas.sella turcica The sella turcica (Latin for 'Turkish saddle') is a saddle-shaped depression in the body of the sphenoid bone of the human skull and of the skulls of other hominids including chimpanzees, gorillas and orangutans. It serves as a cephalometric la ...

, will expand in the direction of least resistance and eventually invade the cavernous sinus. Cavernous sinus syndrome may result from mass effect of these tumors and cause

ophthalmoplegia Ophthalmoparesis refers to weakness (-paresis) or paralysis (-plegia) of one or more extraocular muscles which are responsible for eye movements. It is a physical finding in certain neurologic, ophthalmologic, and endocrine disease. Internal ...

(from compression of the oculomotor nerve, trochlear nerve, and abducens nerve), ophthalmic sensory loss (from compression of the ophthalmic nerve), and maxillary sensory loss (from compression of the maxillary nerve). A complete lesion of the cavernous sinus disrupts CN III, IV, and VI, causing total ophthalmoplegia, usually accompanied by a fixed, dilated pupil. Involvement of CN V (V₁ and variable involvement of V₂) causes sensory loss in these divisions of the trigeminal nerve.

Horner's syndrome Horner's syndrome, also known as oculosympathetic paresis, is a combination of symptoms that arises when a group of nerves known as the sympathetic trunk is damaged. The signs and symptoms occur on the same side (ipsilateral) as it is a lesion ...

can also occur due to involvement of the carotid ocular sympathetics, but may be difficult to appreciate in the setting of a complete third nerve injury.Blumenfeld, H, Neuroanatomy through clinical cases. Sinauer Associates, Inc., 2002. Because of its connections with the

facial vein The facial vein (or anterior facial vein) is a relatively large vein in the human face. It commences at the side of the root of the nose and is a direct continuation of the angular vein where it also receives a small nasal branch. It lies behind ...

via the

superior ophthalmic vein The superior ophthalmic vein is a vein of the orbit that drains venous blood from structures of the upper orbit. It is formed by the union of the angular vein, and supraorbital vein. It passes backwards within the orbit alongside the ophthalmic a ...

, it is possible to get infections in the cavernous sinus from an external facial injury within the danger area of the face. In patients with

thrombophlebitis Thrombophlebitis is a phlebitis (inflammation of a vein) related to a thrombus (blood clot). When it occurs repeatedly in different locations, it is known as thrombophlebitis migrans (migratory thrombophlebitis). Signs and symptoms The following ...

of the facial vein, pieces of the clot may break off and enter the cavernous sinus, forming a

cavernous sinus thrombosis Cavernous sinus thrombosis (CST) is the formation of a blood clot within the cavernous sinus, a cavity at the base of the brain which drains deoxygenated blood from the brain back to the heart. This is a rare disorder and can be of two types–sept ...

. From there the infection may spread to the

. Infections may also be introduced by facial lacerations and by bursting pimples in the areas drained by the facial vein.Kumar, P. & Clark, M. Clinical Medicine, 6th ed. London: W.B. Saunders; 2005. Potential causes of cavernous sinus syndrome include

metastatic tumor Metastasis is a pathogenic agent's spreading from an initial or primary site to a different or secondary site within the host's body; the term is typically used when referring to metastasis by a cancerous tumor. The newly pathological sites, ...

s, direct extension of nasopharyngeal tumours,

meningioma Meningioma, also known as meningeal tumor, is typically a slow-growing tumor that forms from the meninges, the membranous layers surrounding the brain and spinal cord. Symptoms depend on the location and occur as a result of the tumor pressing ...

pituitary tumor Pituitary adenomas are tumors that occur in the pituitary gland. Most pituitary tumors are benign, approximately 35% are invasive and just 0.1% to 0.2% are carcinomas.pituitary apoplexy Pituitary apoplexy is bleeding into or impaired blood supply of the pituitary gland. This usually occurs in the presence of a tumor of the pituitary, although in 80% of cases this has not been diagnosed previously. The most common initial sympt ...

aneurysm An aneurysm is an outward :wikt:bulge, bulging, likened to a bubble or balloon, caused by a localized, abnormal, weak spot on a blood vessel wall. Aneurysms may be a result of a hereditary condition or an acquired disease. Aneurysms can also b ...

s of the intracavernous

carotid artery Carotid artery may refer to: * Common carotid artery, often "carotids" or "carotid", an artery on each side of the neck which divides into the external carotid artery and internal carotid artery * External carotid artery, an artery on each side of ...

, bacterial infection causing cavernous sinus thrombosis, aseptic cavernous sinus thrombosis, idiopathic granulomatous disease (

Tolosa–Hunt syndrome Tolosa–Hunt syndrome is a rare disease, rare disorder characterized by severe and unilateral headaches with orbital pain, along with weakness and paralysis (ophthalmoplegia) of certain eye muscles (extraocular muscle paresis, extraocular palsies) ...

), and fungal infections. Cavernous sinus syndrome is a medical emergency, requiring prompt medical attention, diagnosis, and treatment.

References

External links

* * "Venous dural sinuses." * * * {{Authority control Veins of the head and neck Medical mnemonics