Neurovascular Venous Anatomy

Cavernous Sinus

  • Contents (O TOM CAT) (Top to Bottom)

    • O - Oculomotor nerve (CN 3)

    • T: Trochlear nerve

    • O: Ophthalmic branch of CN 5

    • M: Maxillary branch of CN 5

    • C: Internal carotid artery

    • A: Abducens nerve

    • T: Trochlear nerve (again)

  • Pathology

    • Cavernous sinus thrombosis

    • Carotico-cavernous fistula

    • Mass of cavernous sinus (many possibilities)

      • Schwannoma

      • Meningioma

      • Pituitary macroadenoma

      • Hemangioma

      • Local mass spread (nasopharyngeal, perineural spread from other area)

Meckel’s Cave

  • Sits posterior and lateral to cavernous sinus

  • ICA (lacerum & petrous segments) run underneath the cave

  • Pathology

    • Broadly divided into intrinsic and extrinsic lesions

    • Extrinsic lesions

      • Destroy surrounding bone trying to get into cave

      • Metastasis

      • Chordoma

      • Chondrosarcoma

    • Intrinsic lesions

      • Expand Meckel’s cave trying to get out of cave

      • Schwannoma (most common cause of cave mass)

      • Meningioma

      • Idiopathic intracranial HTN

References:

  • Case courtesy of Frank Gaillard, Radiopaedia.org, rID: 54907

  • Tushar Jha, H Jeffrey kim, and Walter C Jean (Skull Base Surgery: Strategies)