Cavernous Sinus Syndromes

Understanding the clinical management of cavernous sinus syndrome (CCS) requires an extensive understanding of its anatomy. It is a small but complex, and it contains several important structures. The cavernous sinus (CS) is not a venous plexus, but it is a true dural venous sinus. It is bordered by the temporal bone of the skull and the sphenoid bone and lies lateral to the sella turcica. The inferior and lateral walls and the roof of CS are extensions of the dura mater. There may or may not be a thin layer of collagen at the medial wall. The blood-filled space contains the internal carotid artery (carotid siphon) surrounded by sympathetic fibers, as well as cranial nerves (CN). In particular, CN III (oculomotor nerve), IV (trochlear nerve), 2 branches of the V (trigeminal nerve): V1 (ophthalmic) and V2 (maxillary), all pass through this blood-filled space (Figure "Anatomy of the cavernous sinus"). Cavernous sinus syndrome is any disease process involving the CS. CCA is characterized by signs and symptoms resulting in ophthalmoplegia, chemosis, proptosis, Horner syndrome, or trigeminal sensory loss.