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Kenan I. Arnautović, Ossama Al-Mefty, T. Glenn Pait, Ali F. Krisht and Muhammad M. Husain

transverse foramen of the axis to the dural penetration by the VA. We also studied the loops, branches, supporting fibrous rings, and surrounding venous structures of the V 3 , as well as the relationships of these anatomical elements to their surrounding structures. Our study revealed an astonishing anatomical resemblance between this complex and the cavernous sinus. A review of the literature showed their related embryological development and functional and pathological features, as well as similar transitional patterns of the structures of the V 3 and petrous

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Anatomy of the cavernous sinus

A microsurgical study

Frank S. Harris and Albert L. Rhoton Jr.

T he cavernous sinus is located nearly in the center of the head, and has connections with the cerebrum, cerebellum, brain stem, face, eye, orbit, nasopharynx, mastoid, and middle ear. These connections and the relationships of the cavernous, sinus to the carotid artery, extraocular nerves, and pituitary gland make the sinus of special interest to neurologists, neurosurgeons, ophthalmologists, otolaryngologists, and endocrinologists. The sinus is connected to the orbit by the superior and inferior ophthalmic veins, to the cerebral hemispheres through the

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Federico Sadun, Steven E. Feldon, Martin H. Weiss and Mark D. Krieger

F irst described by Duncan in 1821, 8 septic cavernous sinus thrombosis is a rare and severe complication involving a variety of infectious processes of the head and neck region. The disease generally presents with fever, headache, proptosis, ophthalmoplegia, and variable visual impairment. If untreated the infection usually spreads intracranially and is almost uniformly fatal. The widespread use of effective antibiotic therapy has improved the prognosis; nevertheless, the disease is still associated with significant mortality and morbidity. A case of

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Richard P. Mills, Sam J. Insalaco and Allen Joseph

T he sudden disappearance of all eye movement in a patient following neurosurgical intervention prompted repeated diagnostic investigation which remained fruitless for 2 months. Just before the patient died, metastasis of lung cancer to both cavernous sinuses was discovered and later confirmed at postmortem examination. Case Report This 59-year-old man underwent coronary artery bypass grafting 3 months before admission. A right carotid arteriogram ( Fig. 1 ) was obtained during coronary arteriography. A small coin-shaped lesion was found in the left

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Michael S. Edwards and Edward S. Connolly

C avernous sinus syndrome has commonly been associated with fistulous communications between the cavernous sinus and the internal carotid artery. Only 24 cases have been reported in which the major supply was through the external carotid artery 1–6, 8, 10, 13, 14, 17–20 or the vertebral artery. 4 We wish to report two cases in which the major blood supply was through the external carotid artery with a main contribution from the vertebral artery in one case. Case Reports Case 1 A 42-year-old left-handed man developed a pulse-synchronous noise in his

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May N. Tsao, Michael L. Schwartz, Mark Bernstein, William C. Halliday, Alex W. Lightstone, Mark G. Hamilton, Satish Jaywant and Normand Laperriere

: Superselective embolization and surgery of non-involuting hemangiomas and AV malformations. Plast Reconstr Surg 68 : 143 – 152 , 1981 Leikensohn JR, Epstein LI, Vasconez LO: Superselective embolization and surgery of non-involuting hemangiomas and AV malformations. Plast Reconstr Surg 68: 143–152, 1981 23. Linskey ME , Sekhar LN : Cavernous sinus hemangiomas: a series, a review, and an hypothesis. Neurosurgery 30 : 101 – 108 , 1992 Linskey ME, Sekhar LN: Cavernous sinus hemangiomas: a series, a review, and an

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Harry R. van Loveren, Jeffrey T. Keller, Magdy El-Kalliny, Daniel J. Scodary and John M. Tew Jr.

T he intricate and compact neurovascular contents of the cavernous sinus led Dwight Parkinson 10 to describe it as the “anatomical jewel box” ( Fig. 1 ). Because of this complexity, few have dared to approach this region surgically. The perception of an ominous rate of surgical morbidity and mortality resulted in situations in which even benign lesions ran a malignant course. Classic anatomy texts have not provided the essential anatomical detail in a manner suitable for surgical exploration. Fig. 1. Artist's enhancement of Dr. Oscar Batson

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The lateral wall of the cavernous sinus

With special reference to the nerves related to it

Felix Umansky and Hilel Nathan

S ince the first descriptions of the cavernous sinus, 22, 37 numerous anatomical studies have emphasized the importance of this paired venous channel, deep-seated at the sides of the body of the sphenoid bone and the sella turcica. It is generally accepted that the sinuses are located between the two layers of the dura mater: the periosteal (endosteal) layer forming the floor and most of the medial wall of the cavernous sinus, and the dural layer forming its roof, lateral wall, and the upper part of the medial wall ( Fig. 1a ). However, contradictory

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Kazumichi Yamada, Masaki Miura, Haruhiko Miyayama, Naohiko Furuyoshi, Jun Matsumoto and Yukitaka Ushio

involvement. Pediatr Dermatol 10: 64–68, 1993 4. Brück W , Sander U , Blanckenberg P , et al : Symptomatic xanthogranuloma of choroid plexus with unilateral hydrocephalus. Case report. J Neurosurg 75 : 324 – 327 , 1991 Brück W, Sander U, Blanckenberg P, et al: Symptomatic xanthogranuloma of choroid plexus with unilateral hydrocephalus. Case report. J Neurosurg 75: 324–327, 1991 5. El-Kalliny M , van Loveren H , Keller JT , et al : Tumors of the lateral wall of the cavernous sinus. J

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Tamer Altay, Bhupendra C. K. Patel and William T. Couldwell

L esions in the cavernous sinus were long considered inoperable because of the danger of bleeding from the venous plexus or the injury to important neurovascular structures, such as the ICA, the abducent nerve, and the sympathetic nerves. During the past 2 decades, however, meticulous microsurgical studies have described numerous approaches with acceptable morbidity and mortality. 1 , 2 , 7–9 , 11 , 13–15 , 19 , 21 , 23 , 24 Nevertheless, controversy related to the optimal approach for different kinds of lesions continues, and the cavernous sinus is still