The suboccipital cavernous sinus

1997 ◽  
Vol 86 (2) ◽  
pp. 252-262 ◽  
Author(s):  
Kenan I. Arnautović ◽  
Ossama Al-Mefty ◽  
T. Glenn Pait ◽  
Ali F. Krisht ◽  
Muhammad M. Husain
Keyword(s):  
Cavernous Sinus ◽  
Internal Carotid ◽  
Microsurgical Anatomy ◽  
Transverse Foramen ◽  
Cross Sectional ◽  
Anatomical Structures ◽  
Content Type ◽  
Arterial Walls ◽  
Pathological Conditions ◽  
Fine Print

✓ The authors studied the microsurgical anatomy of the suboccipital region, concentrating on the third segment (V3) of the vertebral artery (VA), which extends from the transverse foramen of the axis to the dural penetration of the VA, paying particular attention to its loops, branches, supporting fibrous rings, adjacent nerves, and surrounding venous structures. Ten cadaver heads (20 sides) were fixed in formalin, their blood vessels were perfused with colored silicone rubber, and they were dissected under magnification. The authors subdivided the V3 into two parts, the horizontal (V3h) and the vertical (V3v), and studied the anatomical structures topographically, from the superficial to the deep tissues. In two additional specimens, serial histological sections were acquired through the V3 and its encircling elements to elucidate their cross-sectional anatomy. Measurements of surgically and clinically important features were obtained with the aid of an operating microscope. This study reveals an astonishing anatomical resemblance between the suboccipital complex and the cavernous sinus, as follows: venous cushioning; anatomical properties of the V3 and those of the petrous—cavernous internal carotid artery (ICA), namely their loops, branches, supporting fibrous rings, and periarterial autonomic neural plexus; adjacent nerves; and skull base locations. Likewise, a review of the literature showed a related embryological development and functional and pathological features, as well as similar transitional patterns in the arterial walls of the V3 and the petrous-cavernous ICA. Hence, due to its similarity to the cavernous sinus, this suboccipital complex is here named the “suboccipital cavernous sinus.” Its role in physiological and pathological conditions as they pertain to various clinical and surgical implications is also discussed.

scholarly journals The suboccipital cavernous sinus

1996 ◽  
Vol 1 (6) ◽  
pp. E2
Author(s):  
Kenan I. Arnautovic ◽  
Ossama Al-Mefty ◽  
T. Glenn Pait ◽  
Ali F. Krisht ◽  
Muhammad M. Husain
Keyword(s):  
Cavernous Sinus ◽  
Internal Carotid ◽  
Microsurgical Anatomy ◽  
Review Of The Literature ◽  
Transverse Foramen ◽  
Cross Sectional ◽  
Anatomical Structures ◽  
Arterial Walls ◽  
The Third ◽  
Pathological Conditions

The authors studied the microsurgical anatomy of the suboccipital region, concentrating on the third segment (V3) of the vertebral artery (VA), which extends from the transverse foramen of the axis to the dural penetration of the VA, paying particular attention to its loops, branches, supporting fibrous rings, adjacent nerves, and surrounding venous structures. Ten cadaver heads (20 sides) were fixed in formalin, their blood vessels were perfused with colored silicone rubber, and they were dissected under magnification. The authors subdivided the V3 into two parts, the horizontal (V3h) and the vertical (V3v), and studied the anatomical structures topographically, from the superficial to the deep tissues. In two additional specimens, serial histological sections were acquired through the V3 and its encircling elements to elucidate their cross-sectional anatomy. Measurements of surgically and clinically important features were obtained with the aid of an operating microscope. This study reveals an astonishing anatomical resemblance between the suboccipital complex and the cavernous sinus, as follows: venous cushioning; anatomical properties of the V3 and those of the petrous-cavernous internal carotid artery (ICA), namely their loops, branches, supporting fibrous rings, and periarterial autonomic neural plexus; adjacent nerves; and skull base locations. Likewise, a review of the literature showed a related embryological development and functional and pathological features, as well as similar transitional patterns in the arterial walls of the V3 and the petrous-cavernous ICA. Hence, due to its similarity to the cavernous sinus, this suboccipital complex is here named the "suboccipital cavernous sinus." Its role in physiological and pathological conditions as they pertain to various clinical and surgical implications is also discussed.

Management of carotid-cavernous fistulas by surgery combined with interventional radiology

1983 ◽  
Vol 59 (6) ◽  
pp. 1076-1081 ◽  
Author(s):  
Brian M. Tress ◽  
Kenneth R. Thomson ◽  
Geoffrey L. Klug ◽  
Roger R. B. Mee ◽  
Bruce Crawford
Keyword(s):  
Interventional Radiology ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Balloon Catheter ◽  
Superior Ophthalmic Vein ◽  
Detachable Balloon ◽  
Content Type ◽  
First Case ◽  
Carotid Cavernous Fistulas ◽  
Fine Print

✓ Two cases of carotid-cavernous fistulas were successfully treated by standard interventional radiology techniques after otherwise inaccessible vessels were surgically exposed. In the first case, an internal carotid artery (ICA), which had previously been ligated as part of an attempted surgical “entrapment” procedure, was recanalized to permit passage of a detachable balloon catheter to the fistula, resulting in its obliteration. In the second case, an enlarged superior ophthalmic vein was exposed and isolated to facilitate retrograde catheterization of the cavernous sinus and obliteration of a dural fistula between the ICA and the cavernous sinus by steel Gianturco coils. The methods and complications of both procedures are discussed.

Intracranial mycotic aneurysms of extravascular origin

1972 ◽  
Vol 36 (5) ◽  
pp. 552-559 ◽  
Author(s):  
Charas Suwanwela ◽  
Nitaya Suwanwela ◽  
Srisakul Charuchinda ◽  
Chaturaporn Hongsaprabhas
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Cerebral Arteries ◽  
Content Type ◽  
Mycotic Aneurysms ◽  
Fine Print

✓ Six patients with intracranial mycotic aneurysms of extravascular origin are reported. Four had aneurysms of the intracavernous portion of the internal carotid artery associated with thrombophlebitis of the cavernous sinus, and two had aneurysms of the cerebral arteries associated with meningitis. An aneurysm of this type may rupture, producing subarachnoid hemorrhage, or it may become thrombosed and decrease in size or spontaneously disappear. In some patients it may persist and develop calcification in the wall.

Treatment of bilateral spontaneous dural carotid-cavernous fistulas by coils and sclerotherapy

1987 ◽  
Vol 66 (3) ◽  
pp. 468-470 ◽  
Author(s):  
Patrick Courtheoux ◽  
Daniel Labbe ◽  
Christian Hamel ◽  
Pierre-Joel Lecoq ◽  
Marcio Jahara ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Superior Ophthalmic Vein ◽  
Content Type ◽  
Steel Coils ◽  
Carotid Cavernous Fistulas ◽  
Fine Print

✓ A case of bilateral spontaneous carotid-cavernous fistulas producing increased intraocular pressure is reported. The fistulas lay between the meningeal branches of the internal carotid artery (ICA) and the cavernous sinus, but the ICA itself was not involved. Successful treatment was accomplished by the introduction of steel coils and a sclerotic liquid into the cavernous sinus via the distal superior ophthalmic vein.

Meningiomas involving the cavernous sinus: histological factors affecting the degree of resection

1997 ◽  
Vol 87 (4) ◽  
pp. 535-543 ◽  
Author(s):  
Chandranath Sen ◽  
Karin Hague
Keyword(s):  
Cavernous Sinus ◽  
Internal Carotid ◽  
Skull Base Surgery ◽  
Complete Resection ◽  
Nerve Function ◽  
Content Type ◽  
Factors Affecting ◽  
Cranial Nerve Function ◽  
Histological Factors ◽  
Fine Print

✓ Despite advances in the surgical treatment of meningiomas located at the skull base, surgery for meningiomas involving the cavernous sinus remains controversial. The controversy centers on whether complete resection of such a meningioma is possible while preserving cranial nerve function. To evaluate this question, the authors examined six patients with benign meningiomas involving the cavernous sinus. The pathological features of these tumors were evaluated and compared with the normal histoarchitecture of the cavernous sinus. The tendency of these tumors to be infiltrative is evident and this seems to occur along connective tissue planes within the cavernous sinus. This invasiveness can be explained by the peculiar structure of this region. The trigeminal nerve and ganglion seem to be particularly prone to invasion; this does not correlate with the degree of preoperative impairment of nerve function. Internal carotid artery invasion occurs frequently and can be seen even when there is no narrowing of the artery on arteriography. The pituitary gland can also be invaded by the tumor, which penetrates the thin dural barrier.

Subarachnoid hemorrhage possibly caused by a saccular carotid artery aneurysm within the cavernous sinus

1990 ◽  
Vol 73 (2) ◽  
pp. 301-304 ◽  
Author(s):  
Tatsuya Nishioka ◽  
Akinori Kondo ◽  
Ikuhiro Aoyama ◽  
Kiyoshi Nin ◽  
Jun Takahashi
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Surgical Approach ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Content Type ◽  
Carotid Artery Aneurysm ◽  
Fine Print

✓ Aneurysms arising from the intracavernous portion of the internal carotid artery very rarely rupture. A patient is presented in whom rupture of an aneurysm wholly within the cavernous sinus caused a subarachnoid hemorrhage. The aneurysm was successfully clipped via a direct surgical approach. The possible mechanism by which subarachnoid hemorrhage occurred is briefly discussed.

Surgical alternatives in the treatment of cavernous sinus aneurysms

1989 ◽  
Vol 71 (6) ◽  
pp. 846-853 ◽  
Author(s):  
Fernando G. Diaz ◽  
Sam Ohaegbulam ◽  
Manuel Dujovny ◽  
James I. Ausman
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Visual Loss ◽  
Internal Carotid ◽  
Content Type ◽  
Group 3 ◽  
Group 2 ◽  
Fine Print ◽  
Group 1

✓ Direct surgery on aneurysms in the cavernous sinus is a formidable technical procedure. The intimate relationship of the intracavernous carotid artery to the venous structures and to the cranial nerves make surgical access difficult at best. Thirty-two of 356 aneurysm patients presented with symptomatic aneurysms originating from the intracavernous internal carotid artery. Twenty-one patients had aneurysms contained entirely within the cavernous sinus, and in 11 others the aneurysms arose within the cavernous sinus and extended into the subarachnoid space. Of the purely intracavernous aneurysms there were five small aneurysms (< 25 mm) and 16 giant (≥ 25 mm) aneurysms. Fifteen patients with purely intracavernous lesions had a superior orbital fissure syndrome, and six had a variety of other symptoms. Of 11 patients with subarachnoid extension, five had a subarachnoid hemorrhage (Grade I or II), five had ipsilateral visual loss, and one had periorbital pain. The aneurysms were treated as follows: Group 1 received progressive ligation of the internal carotid artery in the neck with a Selverstone clamp and a surface superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis (purely intracavernous in nine, and with subarachnoid extension in one); Group 2 underwent trapping of the internal carotid artery and a deep STA-MCA anastomosis (purely intracavernous in seven); and Group 3 had direct clipping of the aneurysm (purely intracavernous in five, and with subarachnoid extension in 10). The cavernous sinus was entered directly through its roof by a pterional craniotomy with radical removal of the optic canal, lesser sphenoid wing, and lateral and superior orbital walls. Proximal control of the internal carotid artery was obtained through a cervical incision. Two patients in Group 1 developed transient neurological deficits, which resolved. Two patients in Group 2 developed a cerebral infarction, one of whom died; in both of these patients, the anastomosis was completed after the internal carotid artery occlusion. Two patients in Group 3 progressed from marked visual loss to blindness of the same side, and one developed an intraventricular hemorrhage during induction of anesthesia and died without surgery. It is proposed that a direct approach to symptomatic aneurysms in the cavernous sinus is the best initial alternative. When this approach is not feasible, a trapping procedure preceded by a high-flow extracranial-intracranial anastomosis may be considered. Although the authors have been able to clip aneurysms of various sizes, this has not been possible in all patients. Further work is needed in this area.

Dorello's canal: a microanatomical study

1991 ◽  
Vol 75 (2) ◽  
pp. 294-298 ◽  
Author(s):  
Felix Umansky ◽  
Josef Elidan ◽  
Alberto Valarezo
Keyword(s):  
Cranial Nerve ◽  
Venous Blood ◽  
Abducens Nerve ◽  
Microsurgical Anatomy ◽  
Sixth Cranial Nerve ◽  
Content Type ◽  
Dorello’S Canal ◽  
Pathological Conditions ◽  
Anatomical Relationship ◽  
Fine Print

✓ The microsurgical anatomy of Dorello's canal has been studied in 20 specimens obtained from 10 cadaver heads fixed in formalin. The bow-shaped canal through which courses the abducens nerve before reaching the cavernous sinus is located inside a venous confluence which occupies the space between the dural leaves of the petroclival area. The petrosphenoidal ligament (Gruber's ligament), which forms the posteromedial wall of the canal, appears as a fibrous trabecula surrounded by venous blood. Canal measurements were performed and its anatomical relationship with the sixth cranial nerve is described. Angulations of variable degrees were observed in the course of the nerve inside and outside the canal. The influence of this relatively tortuous course of the abducens nerve upon its vulnerability in some pathological conditions is discussed.

Carotid-cavernous sinus thrombosis caused by Aspergillus fumigatus

1980 ◽  
Vol 52 (1) ◽  
pp. 120-125 ◽  
Author(s):  
Laligam N. Sekhar ◽  
Manuel Dujovny ◽  
Gutti R. Rao
Keyword(s):  
Aspergillus Fumigatus ◽  
Cavernous Sinus ◽  
Sphenoid Sinus ◽  
Internal Carotid ◽  
Sinus Thrombosis ◽  
Sella Turcica ◽  
Cavernous Sinus Thrombosis ◽  
Content Type ◽  
The Central Nervous System ◽  
Fine Print

✓ A case is presented of Aspergillus fumigatus granuloma involving the sphenoid sinus, sella turcica, cavernous sinus, and the internal carotid artery. The diagnosis was established by a transsphenoidal biopsy. The infection proved difficult to treat and finally remitted after chemotherapy with a combination of amphotericin B, rifampin (rifampicin), and flucytosine (5-fluorocytosine). The spectrum of aspergillosis of the central nervous system is reviewed, and difficulties in treating this infection are considered.

The superior wall of the cavernous sinus: a microanatomical study

1994 ◽  
Vol 81 (6) ◽  
pp. 914-920 ◽  
Author(s):  
Felix Umansky ◽  
Alberto Valarezo ◽  
Josef Elidan
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Deep Layer ◽  
Lateral Wall ◽  
Anterior Clinoid Process ◽  
Content Type ◽  
Carotid Canal ◽  
Fine Print

✓ The superior wall of the cavernous sinus was studied in 30 specimens obtained from 15 cadaver heads fixed in formalin. Trapezoidal in shape, the superior wall of cavernous sinus is limited laterally by the anterior petroclinoid ligament, medially by the dura of the diaphragma sellae, anteriorly by the endosteal dura of the carotid canal, and posteriorly by the posterior petroclinoid ligament. An interclinoid ligament bisects the wall, dividing it into two triangles: the carotid trigone anteromedially and the oculomotor trigone posterolaterally. Similar to the lateral wall of the cavernous sinus, the superior wall is formed by two layers: a smooth superficial dural layer and a thin, less defined deep layer. In the area of the carotid trigone, both layers separate to wrap the anterior clinoid process. The removal of this process will reveal a “clinoid space” medial to which the internal carotid artery can be identified. This clinoid segment of the artery, still extracavernous, is surrounded by two fibrous rings: a distal ring formed by fibers of the superficial dural layer and a proximal ring related to the deep dural layer. Below the proximal ring, the internal carotid artery becomes intracavernous; above the distal ring, the artery is continuous with its supraclinoid segment. The complex dural anatomy of the superior wall, its fibrous rings, and the clinoid space in relation to a superior surgical approach to the cavernous sinus are discussed.

Sign in / Sign up

Export Citation Format

Share Document