The cavernous sinus: An anatomic study with clinical implication

IF 1.6 4区医学 Q2 OTORHINOLARYNGOLOGY Laryngoscope Investigative Otolaryngology Pub Date : 2024-03-23 DOI:10.1002/lio2.1226

Myles L. Pensak MD

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Abstract

Objective

The management of lesions involving the cavernous sinus remains a formidable challenge. To optimize care for patients with tumors extending into this skull base region a detailed understanding of the surrounding osteology as well as neural and vascular relationships is requisite. This thesis examines the gross anatomy of the region and highlights important surgical implications drawn from these as well as previously published studies.

Methods

A review of the historical scientific, anatomic, clinical, and surgical literature extending to the present (1992) relating to the cavernous sinus has been performed and discussed. Additionally, the author has performed and described cadaveric dissections revealing novel details about the macroscopic (dural and neurovascular anatomic relationships) and microscopic structure of the cavernous sinus. A series of cases of cavernous sinus pathologies that were addressed in an interdisciplinary surgical approach at the author's institution is also reported.

Results

Included in this report is a comprehensive review of the embryology of the cavernous sinus and its associated neurovascular structures. Cadaveric dissections have also revealed novel details about dural/meningeal compartments of the cavernous sinus as well as well as associated arterial, venous, and neural relationships. Microscopic observations also reveal novel fundamental insights into the components and structure of the cavernous sinus. Clinical examples from 20 patients illustrate the critical importance for clinical application of cavernous sinus anatomic knowledge to the surgical treatment of pathologies in this region.

Conclusion

The cavernous sinus is a tripartite venous osteomeningeal compartment intimately neighboring vital structures including the optic tracts, pituitary gland, cranial nerves III, IV, V, V, VI, and the internal carotid artery. Surgical management of cavernous sinus lesions has and continues to evolve with increasing anatomic and clinical study as well as advancements in diagnostic and surgical methodologies.

Level of Evidence

NA.

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海绵窦：具有临床意义的解剖学研究

目的涉及海绵窦病变的治疗仍然是一项艰巨的挑战。为了优化对颅底区域肿瘤患者的治疗，必须详细了解周围的骨学以及神经和血管关系。本论文研究了该区域的大体解剖结构，并强调了从这些研究和以前发表的研究中得出的重要手术意义。方法回顾了与海绵窦有关的历史科学、解剖学、临床和外科文献，并对其进行了讨论。此外，作者还对尸体进行了解剖和描述，揭示了海绵窦宏观（硬膜和神经血管解剖关系）和微观结构的新细节。此外，还报告了作者所在机构采用跨学科手术方法治疗的一系列海绵窦病理病例。结果本报告全面回顾了海绵窦的胚胎学及其相关的神经血管结构。尸体解剖也揭示了海绵窦硬膜/脑膜区的新细节，以及相关的动脉、静脉和神经关系。显微镜观察也揭示了海绵窦组成和结构的新的基本观点。来自 20 名患者的临床实例说明了海绵窦解剖学知识在该区域病理手术治疗中的临床应用的重要性。结论海绵窦是一个三方静脉骨膜区，与视束、垂体、颅神经 III、IV、V、V、VI 和颈内动脉等重要结构紧密相邻。随着解剖学和临床研究的不断深入以及诊断和手术方法的进步，海绵窦病变的手术治疗也在不断发展。证据级别 NA。

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