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Simplified diagram of tributaries and communication of cavernous sinus

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Simplified anatomical diagram showing the tributaries (inflow) and communications (outflow/connections) of the cavernous sinus. The cavernous sinus is shown as a central labeled box on both sides of the pituitary gland. Inflow tributaries pointing INTO the cavernous sinus: superior ophthalmic vein (from angular vein and supra-orbital vein), inferior ophthalmic vein, sphenoparietal sinus (from superior sagittal sinus), superficial middle cerebral vein, central retinal vein. Outflow and communications: superior petrosal sinus draining into transverse sinus, inferior petrosal sinus draining into internal jugular vein, intercavernous sinuses connecting left and right cavernous sinuses, basilar plexus connecting to vertebral venous plexus, emissary veins through foramen ovale to pterygoid plexus of veins. Inside the cavernous sinus: internal carotid artery and CN VI pass through it; CN III, IV, V1, V2 are in its lateral wall. Clean educational medical diagram with color coding: blue for venous tributaries, green for drainage pathways, red for arterial structures inside sinus, labels for all structures, arrows showing direction of blood flow.

Cavernous Sinus - Tributaries and Communications Diagram

Cavernous Sinus - Tributaries and Communications

Location

The cavernous sinus lies on the lateral aspect of the sphenoid body, flanking the sella turcica on each side. It extends from the superior orbital fissure anteriorly to the apex of the petrous temporal bone posteriorly.

TRIBUTARIES (Inflow into the Cavernous Sinus)

From the Orbit

VeinRoute
Superior ophthalmic veinFormed by angular vein + supra-orbital vein; travels through the orbit and enters via the superior orbital fissure - the main orbital tributary
Inferior ophthalmic veinSmaller; enters directly via the superior orbital fissure OR joins the superior ophthalmic vein first; can also drain into the pterygoid plexus via the inferior orbital fissure
Central retinal veinSmall contribution

From the Brain / Dura

VeinRoute
Sphenoparietal sinusRuns along the lesser wing of the sphenoid; receives diploic and meningeal veins; drains into the anterior end of the cavernous sinus
Superficial middle cerebral veinDrains the lateral cerebral cortex into the sphenoparietal sinus and then cavernous sinus
Hypophyseal veinsLateral hypophyseal veins drain the pituitary gland

From the Face (indirect, via communications)

Facial and nasal infections can reach the cavernous sinus via the angular vein → superior ophthalmic vein route, which is valveless.

COMMUNICATIONS AND DRAINAGE (Outflow)

ChannelWhere it Goes
Superior petrosal sinusBegins at the posterior end of the cavernous sinus; runs along the superior border of the petrous temporal bone → transverse sinus
Inferior petrosal sinusAlso begins at the posterior end; runs in the petro-occipital suture → internal jugular vein; also receives labyrinthine veins from the inner ear
Intercavernous sinusesConnect the right and left cavernous sinuses around the pituitary stalk (anterior and posterior intercavernous sinuses form a venous ring)
Basilar plexusConnects the two inferior petrosal sinuses across the clivus; communicates with the vertebral venous plexus
Emissary vein via foramen ovaleConnects cavernous sinus to the pterygoid plexus of veins in the infratemporal fossa

STRUCTURES INSIDE / RELATED TO THE CAVERNOUS SINUS

Passing through the sinus:
  • Internal carotid artery (ICA) - with its sympathetic plexus
  • CN VI (abducens) - inferolateral to the ICA
Embedded in the lateral wall (superior to inferior):
  1. CN III (oculomotor)
  2. CN IV (trochlear)
  3. CN V1 (ophthalmic division of trigeminal)
  4. CN V2 (maxillary division of trigeminal)

Textbook Image - Orbital Venous Drainage into Cavernous Sinus

This image from Gray's Anatomy for Students shows the orbital tributaries:
Venous drainage of the orbit and eyeball into the cavernous sinus
Fig. 8.103 - Venous Drainage of the Orbit and Eyeball (Gray's Anatomy for Students)

Clinical Relevance

Because the ophthalmic veins are valveless and communicate freely with the cavernous sinus, infections of the face, nose, sinuses, and orbit can spread intracranially to cause cavernous sinus thrombosis. The pterygoid plexus also connects indirectly via emissary veins through the foramen ovale, providing a second route for spread from the infratemporal fossa.
Sources: Gray's Anatomy for Students (pp. 1082, 1026-27); Color Atlas of Human Anatomy Vol. 2 (pp. 132-34); Scott-Brown's Otorhinolaryngology Head & Neck Surgery Vol. 1 (p. 664); Shambaugh Surgery of the Ear
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