Cavernous sinus thrombosis pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]
Overview
The cavernous sinus which is a true dural venous sinus, is irregularly shaped, trabeculated cavities in the base of the skull. The cavernous sinus receives blood via the superior and inferior ophthalmic veins through the: Superior orbital fissure and superficial cortical veins. Cavernous sinus is connected to the basilar plexus of veins posteriorly. There are some important nerves and arteries pass through the cavernous sinus, include: The internal carotid artery (carotid siphon), cranial nerve III, cranial nerve IV, cranial nerve V branches and Cranial nerve VII. Infection from the face may reach the cavernous sinus through its many anastomotic connections, with severe consequences. The cavernous sinus drains by two larger channels, the superior and inferior petrosal sinuses, ultimately into the internal jugular vein via the sigmoid sinus, also draining with emissary vein to pterygoid plexus. These sinuses are just lateral and superior to the sphenoid sinus and are immediately posterior to the optic chiasm. Each cavernous sinus is formed between layers of the dura mater, and multiple connections exist between the 2 sinuses. It is understood that the main cause of cavernous sinus thrombosis is bacterial infections. Staphylococcus aureus may account for two-thirds of cases of cavernous sinus thrombosis. Other typical organisms include: streptococcus species (approximately 20% of cases), Pneumococcus (5%),gram-negative species such as Proteus, hemophilus, Pseudomonas, Fusobacterium, Bacteroides and gram-positive species such as Corynebacterium and Actinomyces. In cavernous sinus thrombosis, a blood clot develops in the sinus cavernous structure to prevent the infection from spreading to brain, but it often blocks the blood flow out of the brain. Septic cases of cavernous sinus thrombosis are usually caused by central facial infections, especially within the danger triangle of the face (from the corners of the mouth to the bridge of the nose). The main sources of infection include: Mastoiditis, Otitis media, Abscess, Cellulitis,Sinusitis and dental infections or procedures. The other rare causes of cavernous sinus thrombosis include: Fungal infections, severe head injuries, autoimmune conditions such as lupus and Pregnancy.
Pathophysiology
The cavernous sinus which is a true dural venous sinus, is irregularly shaped, trabeculated cavities in the base of the skull.[1][2][3]
The cavernous sinus receives blood via the superior and inferior ophthalmic veins through the:[1][4][2][3]
- Superior orbital fissure
- Superficial cortical veins
Cavernous sinus is connected to the basilar plexus of veins posteriorly.
There are some important nerves and arteries pass through the cavernous sinus, include:[4][2][3]
- The internal carotid artery (carotid siphon)
- Cranial nerve III
- Cranial nerve IV
- Cranial nerve V branches:
- Cranial nerve VII
Infection from the face may reach the cavernous sinus through its many anastomotic connections, with severe consequences. The cavernous sinus drains by two larger channels, the superior and inferior petrosal sinuses, ultimately into the internal jugular vein via the sigmoid sinus, also draining with emissary vein to pterygoid plexus. These sinuses are just lateral and superior to the sphenoid sinus and are immediately posterior to the optic chiasm. Each cavernous sinus is formed between layers of the dura mater, and multiple connections exist between the 2 sinuses.[3][5]
Pathogenesis
- It is understood that the main cause of cavernous sinus thrombosis is bacterial infections.[5][6]
- Staphylococcus aureus may account for two-thirds of cases of cavernous sinus thrombosis.
- Other typical organisms include:[5][6]
- Streptococcus species (approximately 20% of cases)
- Pneumococcus (5%)
- Gram-negative species such as Proteus
- Hemophilus
- Pseudomonas
- Fusobacterium
- Bacteroides
- Gram-positive species such as Corynebacterium and Actinomyces
- In cavernous sinus thrombosis, a blood clot develops in the sinus cavernous structure to prevent the infection from spreading to brain, but it often blocks the blood flow out of the brain.[6][5]
- Septic cases of cavernous sinus thrombosis are usually caused by central facial infections, especially within the danger triangle of the face (from the corners of the mouth to the bridge of the nose).[6][5]
- The main sources of infection include:[5]
- Mastoiditis[7]
- Otitis media[8]
- Abscess[9]
- Cellulitis[10]
- Sinusitis[11]
- Dental infections or procedures (even a posterior superior alveolar nerve block entering the pterygoid plexus)[12]
- The other rare causes of cavernous sinus thrombosis include:
- Fungal infections[13]
- Severe head injuries[14]
- Autoimmune conditions such as lupus[15]
- Pregnancy[16]
Associated Conditions
References
- ↑ 1.0 1.1 Chaloupka JC, Goller D, Goldberg RA, Duckwiler GR, Martin NA, Viñuela F (1993). "True anatomical compartmentalization of the cavernous sinus in a patient with bilateral cavernous dural arteriovenous fistulae. Case report". J Neurosurg. 79 (4): 592–5. doi:10.3171/jns.1993.79.4.0592. PMID 8410230.
- ↑ 2.0 2.1 2.2 Bakan AA, Alkan A, Kurtcan S, Aralaşmak A, Tokdemir S, Mehdi E; et al. (2015). "Cavernous Sinus: A Comprehensive Review of its Anatomy, Pathologic Conditions, and Imaging Features". Clin Neuroradiol. 25 (2): 109–25. doi:10.1007/s00062-014-0360-0. PMID 25410584.
- ↑ 3.0 3.1 3.2 3.3 Marinkovic S, Gibo H, Vucevic R, Petrovic P (2001). "Anatomy of the cavernous sinus region". J Clin Neurosci. 8 Suppl 1: 78–81. doi:10.1054/jocn.2001.0883. PMID 11386832.
- ↑ 4.0 4.1 Kehrli P, Maillot C, Wolff MJ (1996). "The venous system of the lateral sellar compartment (cavernous sinus): an histological and embryological study". Neurol Res. 18 (5): 387–93. PMID 8916052.
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Varshney S, Malhotra M, Gupta P, Gairola P, Kaur N (2015). "Cavernous sinus thrombosis of nasal origin in children". Indian J Otolaryngol Head Neck Surg. 67 (1): 100–5. doi:10.1007/s12070-014-0805-4. PMC 4298578. PMID 25621244.
- ↑ 6.0 6.1 6.2 6.3 Clifford-Jones RE, Ellis CJ, Stevens JM, Turner A (1982). "Cavernous sinus thrombosis". J Neurol Neurosurg Psychiatry. 45 (12): 1092–7. PMC 491689. PMID 7161604.
- ↑ Venezio FR, Naidich TP, Shulman ST (1982). "Complications of mastoiditis with special emphasis on venous sinus thrombosis". J Pediatr. 101 (4): 509–13. PMID 7119951.
- ↑ Kuczkowski J (2007). "[Thrombophlebitis of venous sinuses in otitis media]". Otolaryngol Pol. 61 (5): 769–73. doi:10.1016/S0030-6657(07)70523-1. PMID 18552016.
- ↑ Verma R, Junewar V, Singh RK, Ram H, Pal US (2013). "Bilateral cavernous sinus thrombosis and facial palsy as complications of dental abscess". Natl J Maxillofac Surg. 4 (2): 252–5. doi:10.4103/0975-5950.127664. PMC 3961908. PMID 24665189.
- ↑ Allegrini D, Reposi S, Nocerino E, Pece A (2017). "Odontogenic orbital cellulitis associated with cavernous sinus thrombosis and pulmonary embolism: a case report". J Med Case Rep. 11 (1): 164. doi:10.1186/s13256-017-1309-0. PMC 5477346. PMID 28629401.
- ↑ Komatsu H, Matsumoto F, Kasai M, Kurano K, Sasaki D, Ikeda K (2013). "Cavernous sinus thrombosis caused by contralateral sphenoid sinusitis: a case report". Head Face Med. 9: 9. doi:10.1186/1746-160X-9-9. PMC 3605125. PMID 23497466.
- ↑ Yeo GS, Kim HY, Kim H, Kwak EJ, Jung YS, Park HS; et al. (2014). "Cavernous sinus thrombosis caused by a dental infection: a case report". J Korean Assoc Oral Maxillofac Surg. 40 (4): 195–8. doi:10.5125/jkaoms.2014.40.4.195. PMC 4170663. PMID 25247150.
- ↑ Munjal M, Khurana AS (2004). "Fungal infections and cavernous sinus thrombosis". Indian J Otolaryngol Head Neck Surg. 56 (3): 235–7. doi:10.1007/BF02974362. PMC 3451890. PMID 23120086.
- ↑ Ghuman MS, Salunke P, Sahoo SK, Kaur S (2016). "Cerebral venous sinus thrombosis in closed head trauma: A call to look beyond fractures and hematomas!". J Emerg Trauma Shock. 9 (1): 37–8. doi:10.4103/0974-2700.173865. PMC 4766763. PMID 26957825.
- ↑ Singh RK, Bhoi SK, Kalita J, Misra UK (2017). "Cerebral Venous Sinus Thrombosis Presenting Feature of Systemic Lupus Erythematosus". J Stroke Cerebrovasc Dis. 26 (3): 518–522. doi:10.1016/j.jstrokecerebrovasdis.2016.12.001. PMID 28065614.
- ↑ López F, Santamarta E, Martínez P, Sáiz-Ayala A, Llorente JL (2017). "Cavernous sinus thrombosis during pregnancy". Auris Nasus Larynx. 44 (2): 232–236. doi:10.1016/j.anl.2016.04.006. PMID 27146007.