Anatomical study of the lateral wall of the cavernous sinus, emphasizing dural construction and neural relations.
ABSTRACT This study aims to determine the microscopic anatomy of the layers of the lateral wall of the cavernous sinus (CS) and, in particular, intends to examine the location and relations of the dural openings on the deep layer. Forty sides of 20 formalin-fixed and fresh cadavers were dissected and their CS examined. In 12 cases we found an opening on the deep dural layer; however, in four of them the inferolateral trunk of the internal carotid artery (ICA) was identified through these dural openings. We noticed the trochlear nerve making a curve (5% of cases) or lying close to the ophthalmic nerve (12.5%) on the lateral wall. In one case, the triangular area described by Parkinson could not be exposed surgically. Our findings indicate the importance of the heterogeneous courses of the cranial nerves lying on the lateral wall and point to the significance of the dural openings, which can influence the etiology of neoplastic invasions originating from the CS.
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ABSTRACT: Three-dimensional anatomical appreciation of the matrix of the cavernous sinus is one of the crucial necessities for a better understanding of tissue patterning and various disorders in the sinus. The purpose of this study was to reveal configuration of fibrous and adipose components in the cavernous sinus and their relationship with the cranial nerves and vessels in the sinus and meningeal sinus wall. Nineteen cadavers (8 females and 11 males; age range, 54-89 years; mean age, 75 years) were prepared as transverse (6 sets), coronal (3 sets) and sagittal (10 sets) plastinated sections that were examined at both macroscopic and microscopic levels. Two types of the web-like fibrous networks were identified and localized in the cavernous sinus. A dural trabecular network constituted a skeleton-frame in the sinus and contributed to the sleeves of intracavernous cranial nerves III, IV, V1, V2 and VI. A fine trabecular network, or adipose tissue, was the matrix of the sinus and was mainly distributed along the medial side of the intracavernous cranial nerves, forming a dumbbell-shaped adipose zone in the sinus. This study revealed the nature, fine architecture and localization of the fine and dural trabecular networks in the cavernous sinus and their relationship with intracavernous cranial nerves and vessels. The results may be valuable for better understanding of tissue patterning in the cranial base and better evaluation of intracavernous disorders, e.g. the growth direction and extent of intracavernous tumors.PLoS ONE 01/2014; 9(2):e89182. · 3.53 Impact Factor
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ABSTRACT: The purpose of this study was to evaluate the potential of a high-resolution contrast-enhanced magnetic resonance angiography (CE-MRA) at 3 Tesla for the delineation of the cavernous sinus (CS) anatomy both under normal and under pathological conditions. Fifteen patients without pathologies in the CS and ten patients with pituitary adenomas were included. The CE-MRA was performed on a 3-Tesla scanner and analyzed collaboratively by two readers. The cranial nerves (CNs) within the CS, namely CNIII, CNIV, CNV1, CNV2, and CNVI, were identified in both patient groups. In the adenoma patients it was also assessed whether and to which extend the adenoma invaded the CS and the spatial relationship between tumor and CNs was determined. In the patients with normal CS anatomy, CNIII could be identified in 100%, CNIV in 86.7%, and CNV1, CNV2, as well as CNVI in 100% of analyzed sides. Pituitary adenomas invaded the CS unilaterally (right side) in four patients, and bilaterally in six patients. In patients with adenomas, the CN could be identified and differentiated from the tumor in the following percentages: CNIII in 100%, CNIV in 70%, both CNV1 and CNV2 in 90%, and CNVI in 100%. In all these cases, the tumor-nerve spatial relationship could be visualized. 3-Tesla CE-MRA allows detailed imaging of the complex anatomy of the CS and its structures. In adenoma patients, it clearly visualizes the spatial relationship between tumor and CNs, and thus might be helpful to optimize presurgical planning.Neuroradiology 12/2011; 53(12):947-54. · 2.70 Impact Factor
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ABSTRACT: The purpose of this study is to apply contrast-enhanced 3D fast-imaging employing steady-state acquisition (3D-FIESTA) imaging to the evaluation of cranial nerves (CN) in patients with cavernous sinus tumors. Contrast-enhanced 3D-FIESTA images were acquired from ten patients with cavernous sinus tumors with a 3-T unit. In all cases, the trigeminal nerve with tumor involvement was easily identified in the cavernous portions. Although oculomotor and abducens nerves were clearly visualized against the tumor area with intense contrast enhancement, they were hardly identifiable within the area lacking contrast enhancement. The trochlear nerve was visualized in part, but not delineated as a linear structure outside of the lesion. Contrast-enhanced 3D-FIESTA can be useful in the assessment of cranial nerves in and around the cavernous sinus with tumor involvement.Neuroradiology 03/2009; 51(7):467-70. · 2.70 Impact Factor